重症急性呼吸窘迫综合征临床资料回顾性分析

发布时间：2018-06-13 11:03

  本文选题：急性呼吸窘迫综合征 + 回顾性分析　； 参考：《第三军医大学》2013年硕士论文

【摘要】：研究背景和目的 急性呼吸窘迫综合征(ARDS)是指排除心源性因素后，由各种肺内外原因(严重的感染、休克及创伤等疾病)引起弥漫性肺实质内肺泡上皮细胞、肺毛细血管内皮细胞的损伤，以肺容积及肺顺应性减低， V/Q比例严重失衡为病理生理学特点，临床上表现为急性、进行性缺氧性呼吸衰竭及呼吸窘迫。ARDS为目前常见的危重病，涉及多个学科领域。估计全世界每十万人口就有15-75例确诊ARDS患者，每年全球有数以万计的病例发生，，并且长期保持着较高发病率和居高不下的死亡率。本研究对我院ICU的重症ARDS患者的临床资料进行回顾性分析，目的是探讨重症ARDS患者的发病诱因、病死率及影响预后相关因素。 方法 收集我院呼吸科ICU2009年1月-2012年1月期间所有符合1999年9月中华医学会呼吸病学分会在昆明召开的全国呼吸衰竭会议推荐的诊断标准，在此标准基础上将PaO2/FiO2150mmHg作为重症ARDS的纳入标准。收集临床资料包括：一般情况如患者性别、年龄、诱因、慢性病史，ARDS确诊24h内患者的生命体征、血气分析、氧合指数、血常规、肾功能、电解质、降钙素原、CRP、血沉、乳酸、急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ评分)、ARDS确诊后的治疗方法、ICU滞留时间、机械通气时间、多器官功能障碍的发生率以及确诊后21天的病死率。目的是了解重症ARDS患者各项临床指标在生存组和死亡组之间是否存在统计学差异以及与患者病情的相关关系，探寻能预测重症ARDS患者预后的指标。 结果 1.入选重症ARDS病例共计34例，其中男性28例,女性6例,年龄在18～98岁之间,平均年龄(54.09±18.34)岁。直接肺损伤29例(85.3%),间接肺损伤5例(14.7%)。共死亡患者24例(70.6%)。23例患者合并MODS。 2.重症ARDS患者中死亡组APACHEⅡ评分、血清乳酸及降钙素原水平显著高于存活组[分别为(23.42±4.59)vs(16.70±1.57),(4.83±3.60)vs(2.88±0.85)mmol/L,(3.02±2.87)vs(1.20±0.73)ng/L; P＜0.05],而氧合指数明显低于存活组[(80.92±29.29)vs(112.30±24.49)mmHg; P＜0.05]。 3.重症ARDS患者APACHEⅡ评分与血清乳酸及降钙素原水平正相关(r=0.531,r=0.527; P＜0.01)。 4.重症ARDS患者中出现1个器官衰竭的11例,存活5例(45.5%)，而出现2个器官功能衰竭的病例11例,存活4例(36.4%),器官功能衰竭≥3个的患者有12例,仅存活1例(8.3%)。 结论 血清乳酸及降钙素原浓度在重症ARDS患者存活组与死亡组间存在统计学差异，并且与重症ARDS患者病情严重程度正相关。血清乳酸、降钙素原联合APACHEⅡ评分可能有助于判断重症ARDS患者的预后。重症ARDS患者以原发病为主的对症治疗以及早期对多器官功能的保护的综合治疗能提高患者的生存率。
[Abstract]:Background and objective Acute Respiratory distress Syndrome (ARDS) refers to diffuse alveolar epithelial cells in the parenchyma of the lung caused by various causes (severe infection, shock, trauma, etc.) after cardiogenic factors are excluded. The injury of pulmonary capillary endothelial cells was characterized by decreased lung volume and lung compliance, serious imbalance of V / Q ratio, acute, progressive hypoxic respiratory failure and respiratory distress. It covers a wide range of disciplines. It is estimated that there are 15-75 diagnosed ARDS cases per 100,000 people in the world. Every year, tens of thousands of cases occur in the world, and the high incidence and high mortality rate are maintained for a long time. The aim of this study was to investigate the risk factors, mortality and prognostic factors of severe ARDS patients in ICU. Methods from January 2009 to January 2012, all the diagnostic criteria which were recommended by the National Respiratory failure Conference held by the Chinese Medical Association Respiratory Society in Kunming from January 2009 to January 2012 were collected. Pao _ 2 / Fio _ 2150 mmHg was added to the standard for severe ARDS. Clinical data were collected including: general conditions such as gender, age, inducement, vital signs, blood gas analysis, oxygenation index, blood routine examination, renal function, electrolyte, calcitonin proto CRP, erythrocyte sedimentation rate, lactic acid, chronic history of ARDS within 24 hours. Acute Physiology and chronic Health status scoring system 鈪

本文编号：2013810