CAJ | 학술논문

目的对脓毒症和非脓毒症导致的急性呼吸窘迫综合征(ARDS)患者进行一般情况、实验室指标、疾病严重程度、临床行为、疾病预后等临床分析.方法回顾性收集2000年1月至2012年6月解放军总医院收治的符合2011年柏林ARDS定义会议提出的ARDS诊断标准、资料完整的161例患者的相关数据,并根据ARDS发病原因将入选的患者分为脓毒症组和非脓毒症组,比较两组患者的临床特征差异.结果符合诊断标准的180例ARDS患者中,19例因经济等原因放弃治疗,最终161例患者纳入分析,脓毒症组120例(74.5％),其中肺部感染所致占82.5％.脓毒症组在ARDS确诊24 h内血肌酐和总胆红素水平明显低于非脓毒症组(P值分别为0.007、0.006),两组患者氧合指数、APACHEⅡ评分、SOFA评分和肺损伤评分以及器官衰竭情况差异无统计学意义.非脓毒症组有创机械通气时间明显大于脓毒症组(中位数,10 d vs 6 d,P=0.008),但两组医院病死率、存活者机械通气时间等差异均无统计学意义.轻、中、重度ARDS患者分层分析表明医院病死率、28 d病死率、氧合指数、肺损伤评分和SOFA评分等三组具有明显差异,中度ARDS其脓毒症组体质量指数、氧合指数、有创机械通气时间低于非脓毒症组,APACHEⅡ评分高于非脓毒症组,而重度ARDS其脓毒症组APACHEⅡ评分低于非脓毒症组,且轻、中、重度ARDS其脓毒症组与非脓毒症组病死率差异均无统计学意义.结论脓毒症是ARDS的主要病因,脓毒症组具有较低的有创机械通气时间,其病死率、疾病严重程度与非脓毒症组无明显差异.轻、中、重度ARDS病死率、疾病严重程度具有显著差异.
목적 대농독증화비농독증도치적급성호흡군박종합정(ARDS)환자진행일반정황、실험실지표、질병엄중정도、림상행위、질병예후등림상분석.방법 회고성수집2000년1월지2012년6월해방군총의원수치적부합2011년백림ARDS정의회의제출적ARDS진단표준、자료완정적161례환자적상관수거,병근거ARDS발병원인장입선적환자분위농독증조화비농독증조,비교량조환자적림상특정차이.결과 부합진단표준적180례ARDS환자중,19례인경제등원인방기치료,최종161례환자납입분석,농독증조120례(74.5％),기중폐부감염소치점82.5％.농독증조재ARDS학진24 h내혈기항화총담홍소수평명현저우비농독증조(P치분별위0.007、0.006),량조환자양합지수、APACHEⅡ평분、SOFA평분화폐손상평분이급기관쇠갈정황차이무통계학의의.비농독증조유창궤계통기시간명현대우농독증조(중위수,10 d vs 6 d,P=0.008),단량조의원병사솔、존활자궤계통기시간등차이균무통계학의의.경、중、중도ARDS환자분층분석표명의원병사솔、28 d병사솔、양합지수、폐손상평분화SOFA평분등삼조구유명현차이,중도ARDS기농독증조체질량지수、양합지수、유창궤계통기시간저우비농독증조,APACHEⅡ평분고우비농독증조,이중도ARDS기농독증조APACHEⅡ평분저우비농독증조,차경、중、중도ARDS기농독증조여비농독증조병사솔차이균무통계학의의.결론 농독증시ARDS적주요병인,농독증조구유교저적유창궤계통기시간,기병사솔、질병엄중정도여비농독증조무명현차이.경、중、중도ARDS병사솔、질병엄중정도구유현저차이.
Objective To investigate the general data,laboratory parameters,disease severity,clinical behavior,and prognosis in sepsis-induced and non-sepsis-induced ARDS patients.Methods 161patients treated in Chinese PLA general hospital from January 2000 to June 2012 were enrolled into our study according to the 2011 Berlin Definition of Acute respiratory distress syndrome.They were divided into sepsis-induced and non-sepsis induced ARDS due to their etiology,and their diversity was compared.Results Among these 180 patients selected,19 patients who refused treatment were excluded from statistics,and 161 cases were finally brought into analysis.The sepsis-induced ARDS was 120 cases (74.5％) and the main cause was pulmonary infection (82.5％).Within the 24 hours of ARDS diagnosis,septic patients had obvious lower serum creatinine and total bilirubin levels.Among the other indicators,including PaO2/FiO2 ratio,APACHE Ⅱ score,SOFA,lung injury scores (LIS),and multiple organ dysfunction,no statistics distinction was observed.The invasive mechanical ventilation days in non-sepsis related group was longer than that in septic group (median,ten days vs six days,P =0.008),there was no statistical significance in hospital mortality and mechanical ventilation days in survivors.There was statistical significance in the hospital mortality,28-day mortality,oxygenation index,LIS,and SOFA scores among mild,moderate,and severe levels of ARDS.In moderate level of ARDS,BMI,PaO2/FiO2ratio,and invasive mechanical ventilation days were lower and APACHE Ⅱ score was higher in septic group than those in non-sepsis-induced group.And there was no statistical significance in mortality rate between two groups among all levels.Conclusions Sepsis is the main reason of ARDS,which owns less invasive mechanical ventilation days and no difference with non-sepsis in mortality and disease severity.Stage of mild,moderate,and severe ARDS is associated with increased mortality and visible discrepancy of disease severity.