CAJ | 학술논문

目的筛选出影响多发伤合并急性呼吸窘迫综合征死亡率的危险冈素.方法 2003年5月至2008年4月间浙江大学医学院附属第二医院ICU收治符合筛选标准的多发伤患者269例.收集患者入住ICU时的一般资料、治疗措施、损伤严理度评分与APACHE Ⅱ评分.ARDS诊断参照中华医学会2006指南标准,多发伤被认为足南一个致伤因素引起的两处或两处以上的损伤,其中有一处损伤可能是危及生命的.人选标准:年龄≥18岁,ICU监护时间t≥48 h 目机械通气时间≥24 h.排除标准:1)由于非创伤原因再次入住ICU或已在其他医院经过较长时间治疗后再转入ICU者;2)创伤合并溺水;3)胸部创伤合并有毒气体1及入;4)药物或氧中毒;5)住院期间接受过体外循环治疗;6)有心血管疾病或慢性肝病;7)未治愈的肺部感染或长期肺功能不全.所有患者在抗生素、糖皮质激素使用及机械通气方面近乎标准治疗.在第28大时行死亡率评估.通过回顾定群多因素研究,对23项潜在危险因素的单变量与多变量进行logistic回归分析.结果 269例多发伤合并急性呼吸窘迫综合征机械通气时间超过24 h的患者最后进入该研究.与存活组相比,死亡组的APACHE Ⅱ评分更高.269例患者的未校正相埘危险度与下列因素相关:APACHE Ⅱ评分,致伤持续时间,肺挫伤,胃内容物误吸,脓毒症与机械通气时间.对存活超过96 h的患者,影响死亡率的相关因素是APACHE Ⅱ评分,致伤持续时间与胃内容物误吸.APACHE Ⅱ评分＞20患者的预期危险因素为:致伤持续时间,脓毒症与机械通气时间.对机械通气时≥17 d患者的相关危险因素为致伤持续时间与脓毒症.结论肺挫伤、APACHE Ⅱ评分为影响多发伤早期死亡率的危险因素.脓毒症一直是系统性炎症反应综合征、感染、多脏器功能障碍的高危因素.胃内容物的误吸引起严重的呼吸机相关性肺炎将导致死亡率增加.致伤持续时间的长短既影响近期死亡率也影响远期死亡率.长时间的机械通气将引起更多严重的并发症而导致死亡率的进一步上升. 目的篩選齣影響多髮傷閤併急性呼吸窘迫綜閤徵死亡率的危險岡素.方法 2003年5月至2008年4月間浙江大學醫學院附屬第二醫院ICU收治符閤篩選標準的多髮傷患者269例.收集患者入住ICU時的一般資料、治療措施、損傷嚴理度評分與APACHE Ⅱ評分.ARDS診斷參照中華醫學會2006指南標準,多髮傷被認為足南一箇緻傷因素引起的兩處或兩處以上的損傷,其中有一處損傷可能是危及生命的.人選標準:年齡≥18歲,ICU鑑護時間t≥48 h 目機械通氣時間≥24 h.排除標準:1)由于非創傷原因再次入住ICU或已在其他醫院經過較長時間治療後再轉入ICU者;2)創傷閤併溺水;3)胸部創傷閤併有毒氣體1及入;4)藥物或氧中毒;5)住院期間接受過體外循環治療;6)有心血管疾病或慢性肝病;7)未治愈的肺部感染或長期肺功能不全.所有患者在抗生素、糖皮質激素使用及機械通氣方麵近乎標準治療.在第28大時行死亡率評估.通過迴顧定群多因素研究,對23項潛在危險因素的單變量與多變量進行logistic迴歸分析.結果 269例多髮傷閤併急性呼吸窘迫綜閤徵機械通氣時間超過24 h的患者最後進入該研究.與存活組相比,死亡組的APACHE Ⅱ評分更高.269例患者的未校正相塒危險度與下列因素相關:APACHE Ⅱ評分,緻傷持續時間,肺挫傷,胃內容物誤吸,膿毒癥與機械通氣時間.對存活超過96 h的患者,影響死亡率的相關因素是APACHE Ⅱ評分,緻傷持續時間與胃內容物誤吸.APACHE Ⅱ評分＞20患者的預期危險因素為:緻傷持續時間,膿毒癥與機械通氣時間.對機械通氣時≥17 d患者的相關危險因素為緻傷持續時間與膿毒癥.結論肺挫傷、APACHE Ⅱ評分為影響多髮傷早期死亡率的危險因素.膿毒癥一直是繫統性炎癥反應綜閤徵、感染、多髒器功能障礙的高危因素.胃內容物的誤吸引起嚴重的呼吸機相關性肺炎將導緻死亡率增加.緻傷持續時間的長短既影響近期死亡率也影響遠期死亡率.長時間的機械通氣將引起更多嚴重的併髮癥而導緻死亡率的進一步上升.
목적 사선출영향다발상합병급성호흡군박종합정사망솔적위험강소.방법 2003년5월지2008년4월간절강대학의학원부속제이의원ICU수치부합사선표준적다발상환자269례.수집환자입주ICU시적일반자료、치료조시、손상엄리도평분여APACHE Ⅱ평분.ARDS진단삼조중화의학회2006지남표준,다발상피인위족남일개치상인소인기적량처혹량처이상적손상,기중유일처손상가능시위급생명적.인선표준:년령≥18세,ICU감호시간t≥48 h 목궤계통기시간≥24 h.배제표준:1)유우비창상원인재차입주ICU혹이재기타의원경과교장시간치료후재전입ICU자;2)창상합병닉수;3)흉부창상합병유독기체1급입;4)약물혹양중독;5)주원기간접수과체외순배치료;6)유심혈관질병혹만성간병;7)미치유적폐부감염혹장기폐공능불전.소유환자재항생소、당피질격소사용급궤계통기방면근호표준치료.재제28대시행사망솔평고.통과회고정군다인소연구,대23항잠재위험인소적단변량여다변량진행logistic회귀분석.결과 269례다발상합병급성호흡군박종합정궤계통기시간초과24 h적환자최후진입해연구.여존활조상비,사망조적APACHE Ⅱ평분경고.269례환자적미교정상시위험도여하렬인소상관:APACHE Ⅱ평분,치상지속시간,폐좌상,위내용물오흡,농독증여궤계통기시간.대존활초과96 h적환자,영향사망솔적상관인소시APACHE Ⅱ평분,치상지속시간여위내용물오흡.APACHE Ⅱ평분＞20환자적예기위험인소위:치상지속시간,농독증여궤계통기시간.대궤계통기시≥17 d환자적상관위험인소위치상지속시간여농독증.결론 폐좌상、APACHE Ⅱ평분위영향다발상조기사망솔적위험인소.농독증일직시계통성염증반응종합정、감염、다장기공능장애적고위인소.위내용물적오흡인기엄중적호흡궤상관성폐염장도치사망솔증가.치상지속시간적장단기영향근기사망솔야영향원기사망솔.장시간적궤계통기장인기경다엄중적병발증이도치사망솔적진일보상승.
Objective To retrospectively demonstrate risk factors for mortality in multiple trauma patients with acute respiratory distress syndrome(ARDS).Method This wes a retrospective cohort stuay regarding multi-ple trauma as a single cause for intensive care unit admission.Patients identified multiple trauma with ARDS en-rolled in prospectively maintained database between May 2003 and April 2008 were observed,and 23 items of po-tential risk factors of impacting mortality were calculated by univariate and multivariate logistic analyses in order to find distinctive items in these multiple trauma patients.Information on patients demographics characteristics,treat-ment procedures and injury severity were collected at the time of EICU admission.The criteria used for ARDS met definition of the guideline(2006)of Chinese medical association.The commonly accepted definition of multiple injuries was consistent with both several injury sites(generated from two or more than two anatomic sites)and in-jury in one anatomic site at least threatening life.Severity of injury was quantified by injury severity seore and the simplified acute physiology score and chronic health evaluation score (APACHE Ⅱ)in EICU admission.We in-cluded adult patients(age≥18 years),those with an EICU length of stay longer than 48 hours,and those accept-ing mechanical ventilation more than 24 hours.Patients who were readmitted to EICU by virtue of non-traffic injury or transferred to EICU from other hospitals after long-term treatment were excluded.Mortality was assessed at the 28th clay after trauma.Results There were 269 multiple trauma patients with posttranmatic ARDS admitted to ICU during the study period,the unadjusted odds ratio(OR)and 95% confidence intervals(CI)of mortality were associated with six risk factors(APACHE Ⅱ score,duration of tratuna factor,pulmonary contusion,aspiration of gastric contents,sepsis and duration of mechanical ventilation)out of 23 items.The adjusted Odds Ratios(ORs) with 95% CI were denoted with respect to surviving beyond 96 hours ICU admission(APACHE Ⅱ score,duration of trauma factor,aspiration of gastric contents),APACHE Ⅱ score beyond 20 ICU admission(duration of trauma factor,scpsis,duration of mechanical ventilation)and mechanical ventilation beyond 7 days ICU admission(dura-tion of trauma factor and sepsis).Conclusions Impact of pulmonary contusion and APACHE Ⅱ score contribut-ing to prediction of mortality may exist in prophase after multiple trauma.Sepsis is still a vital risk factor referring to systemic inflammatory response syndrome,infection,and secondary multiple organs dysthnetion.Aspiration of gastric contents could lead to incremental mortality due to scvere ventilation associated pneumonia.Duration of trauma factor determined degree of injury and outcomes,longer duration generally manifested higher mortality.Long-standing mechanical ventilation should be constrained on account of occurring severe refractory complications.