中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2009年
23期
1602-1606
,共5页
伍峻松%盛蕾%马岳峰%王沈华%周文%陈金明%张茂%徐少文%江观玉
伍峻鬆%盛蕾%馬嶽峰%王瀋華%週文%陳金明%張茂%徐少文%江觀玉
오준송%성뢰%마악봉%왕침화%주문%진금명%장무%서소문%강관옥
创伤和损伤%呼吸窘迫综合征,成人型%弥散性血管内凝血%脓毒症%损伤严重度评分
創傷和損傷%呼吸窘迫綜閤徵,成人型%瀰散性血管內凝血%膿毒癥%損傷嚴重度評分
창상화손상%호흡군박종합정,성인형%미산성혈관내응혈%농독증%손상엄중도평분
Trauma and injury%Respiratory distress syndrome,adult%Disseminated intravascular coagulation%Sepsis%Injury severity score
目的 研究影响严重创伤合并急性肺损伤恶化进展为急性呼吸窘迫综合征的潜在危险因素.方法 回顾性分析严重创伤患者375例,通过单因素和多因素逻辑回归分析法对20个潜在影响急性肺损伤恶化进展的危险因素进行研究.结果 所有严重创伤合并急性肺损伤患者纳入研究,分析得出6个影响急性肺损伤进展为急性呼吸窘迫综合征的危险因素是:脓毒症、创伤持续时间、APACHE Ⅱ评分、弥漫性血管内凝血(DIC)、胃肠返流、高龄;同时发现这些特定的危险因素对不同的分层患者人群具有不同的影响程度.结论 脓毒症、DIC和创伤持续时间对急性肺损伤恶化进展为急性呼吸窘迫综合征的影响是始终贯穿于整个治疗期;胃肠返流和APACHE Ⅱ评分对病情进展的预测仅仅存在于创伤后的早期阶段;由于严重的创伤性打击和肺功能的衰退,高龄仍旧是影响急性肺损伤进展的独立危险因素.具备这些危险因素的患者必须尽可能早的接受积极治疗以阻止进一步恶化.
目的 研究影響嚴重創傷閤併急性肺損傷噁化進展為急性呼吸窘迫綜閤徵的潛在危險因素.方法 迴顧性分析嚴重創傷患者375例,通過單因素和多因素邏輯迴歸分析法對20箇潛在影響急性肺損傷噁化進展的危險因素進行研究.結果 所有嚴重創傷閤併急性肺損傷患者納入研究,分析得齣6箇影響急性肺損傷進展為急性呼吸窘迫綜閤徵的危險因素是:膿毒癥、創傷持續時間、APACHE Ⅱ評分、瀰漫性血管內凝血(DIC)、胃腸返流、高齡;同時髮現這些特定的危險因素對不同的分層患者人群具有不同的影響程度.結論 膿毒癥、DIC和創傷持續時間對急性肺損傷噁化進展為急性呼吸窘迫綜閤徵的影響是始終貫穿于整箇治療期;胃腸返流和APACHE Ⅱ評分對病情進展的預測僅僅存在于創傷後的早期階段;由于嚴重的創傷性打擊和肺功能的衰退,高齡仍舊是影響急性肺損傷進展的獨立危險因素.具備這些危險因素的患者必鬚儘可能早的接受積極治療以阻止進一步噁化.
목적 연구영향엄중창상합병급성폐손상악화진전위급성호흡군박종합정적잠재위험인소.방법 회고성분석엄중창상환자375례,통과단인소화다인소라집회귀분석법대20개잠재영향급성폐손상악화진전적위험인소진행연구.결과 소유엄중창상합병급성폐손상환자납입연구,분석득출6개영향급성폐손상진전위급성호흡군박종합정적위험인소시:농독증、창상지속시간、APACHE Ⅱ평분、미만성혈관내응혈(DIC)、위장반류、고령;동시발현저사특정적위험인소대불동적분층환자인군구유불동적영향정도.결론 농독증、DIC화창상지속시간대급성폐손상악화진전위급성호흡군박종합정적영향시시종관천우정개치료기;위장반류화APACHE Ⅱ평분대병정진전적예측부부존재우창상후적조기계단;유우엄중적창상성타격화폐공능적쇠퇴,고령잉구시영향급성폐손상진전적독립위험인소.구비저사위험인소적환자필수진가능조적접수적겁치료이조지진일보악화.
Objectives To investigate the potential risk factors of affecting progression from acute lung injury (ALI) to acute respiratory distress syndrome in severe trauma population. Methods Twenty potential risk factors of affecting progression of acute lung injury were examined by univariate and multivariate logistic analyses among the severe trauma patients in a retrospective study. Results All of 375 specially severe trauma patients with ALI were included for analysis. The six risk factors that affected the progression from acute lung injury to acute respiratory distress syndrome were sepsis, duration of trauma, APACHE Ⅱ score, DIC, aspiration of gastric contents, and advanced age. Specific risk factors also affected different patient subpopulations at different degrees. Conclusion Impact of sepsis, DIC and duration of trauma that predict progression of ALI exists throughout the entire treatment period while aspiration of gastric contents and APACHE Ⅱ score might affect aggravation of ALI only during the early period; due to deterioration of pulmonary function and severely traumatic injury, advanced age is still an independent risk factor; patients with these risk factors need aggressive supportive cares as early as poasible in order to prevent further aggravations.
