CAJ | 학술논문

目的：比较欧美联席会议（ American－European Consensus Conference， AECC）和柏林标准对于急性呼吸窘迫综合征（ acute respiratory distress syndrome， ARDS）病死率预测的有效性。方法回顾性分析中国医学科学院肿瘤医院重症医学科（ intensive care unit， ICU）2007－01～2009－10收治的全部 ARDS患者资料。结果根据 AECC 标准，全组25例急性肺损伤（ ALI），68例ARDS。与ALI患者比较，ARDS患者的病情重（转入时 APACHEⅡ评分14．50±7．87比14．42±4．40，P＝0．004）、需要更高的PEEP水平[（5．14±0．38）cm H2O比（6．20±2．17）cm H2O，P＝0．048）、ICU 病死率（4．0％比31．2％，P ＝0．014）和住院病死率更高（8．0％比31．2％，P＝0．042）。根据柏林标准，全组25例轻度ARDS，64例中度ARDS，4例重度ARDS。随着分期的增加，患者的病情逐渐加重（转入时APACHEⅡ评分14．50±7．87比15．47±6．21比16．50±3．70， P＝0．016）、需要更高的PEEP水平[（5．14±0．38）cm H2O比（5．71±1．49）cm H2O比（9．00±3．61）cm H2O，P＝0．048]、ICU病死率（4．0％比31．2％比50．0％，P＝0．014）和住院病死率更高（8．0％比31．2％比50．0％，P ＝0．042）。受试者工作特征曲线分析发现，AECC和柏林标准预测ICU病死率的受试者工作曲线下面积分别为0．650±0．059（95％CI 0．533～0．766，P＝0．032）和0．665±0．060（95％CI 0．548～0．781，P＝0．018）。结论 AECC分期和柏林分期均能从临床呼吸机指标方面和近期预后方面很好地对ALI／ARDS患者进行分层。由于柏林分期将ARDS分为轻度、中度和重度，因此该项标准可能更好地指导临床实践和科学研究。
목적：비교구미련석회의（ American－European Consensus Conference， AECC）화백림표준대우급성호흡군박종합정（ acute respiratory distress syndrome， ARDS）병사솔예측적유효성。방법회고성분석중국의학과학원종류의원중증의학과（ intensive care unit， ICU）2007－01～2009－10수치적전부 ARDS환자자료。결과근거 AECC 표준，전조25례급성폐손상（ ALI），68례ARDS。여ALI환자비교，ARDS환자적병정중（전입시 APACHEⅡ평분14．50±7．87비14．42±4．40，P＝0．004）、수요경고적PEEP수평[（5．14±0．38）cm H2O비（6．20±2．17）cm H2O，P＝0．048）、ICU 병사솔（4．0％비31．2％，P ＝0．014）화주원병사솔경고（8．0％비31．2％，P＝0．042）。근거백림표준，전조25례경도ARDS，64례중도ARDS，4례중도ARDS。수착분기적증가，환자적병정축점가중（전입시APACHEⅡ평분14．50±7．87비15．47±6．21비16．50±3．70， P＝0．016）、수요경고적PEEP수평[（5．14±0．38）cm H2O비（5．71±1．49）cm H2O비（9．00±3．61）cm H2O，P＝0．048]、ICU병사솔（4．0％비31．2％비50．0％，P＝0．014）화주원병사솔경고（8．0％비31．2％비50．0％，P ＝0．042）。수시자공작특정곡선분석발현，AECC화백림표준예측ICU병사솔적수시자공작곡선하면적분별위0．650±0．059（95％CI 0．533～0．766，P＝0．032）화0．665±0．060（95％CI 0．548～0．781，P＝0．018）。결론 AECC분기화백림분기균능종림상호흡궤지표방면화근기예후방면흔호지대ALI／ARDS환자진행분층。유우백림분기장ARDS분위경도、중도화중도，인차해항표준가능경호지지도림상실천화과학연구。
Objective To compare the effectiveness of American -European Consensus Conference ( AECC) and Berlin criteria in predicting the mortality of acute respiratory distress syndrome patients.Methods The data of patients who admitted to intensive care unit ( ICU) of Cancer Hospital Chinese Academy of Medical Sciences were retrospectively reviewed and analyzed.Results There were 25 acute lung injury and 68 acute respiratory distress syndrome ( ARDS) patients according to AECC criteria.Compared with acute lung injury patients, patients who diagnosed as ARDS had more severe disease (APACHEⅡ score 14.50 ±7.87 vs 14.42 ±4.40, P =0.004), higher positive end -expiratory pressure level [(5.14 ±0.38)cm H2O vs (6.20 ±2.17)cm H2O, P=0.048], higher ICU mortality (4.0%vs 31.2%, P=0.014) and hospital mortality (8.0%vs 31.2%, P=0.042).There were 25 mild ARDS,64 moderate and 4 severe ARDS patients.Compared with mild ARDS, patients who were diagnosed as moderate or severe ARDS had more severe disease ( APACHEⅡ score14.50 ± 7.87 vs 15.47 ±6.21 vs 16.50 ±3.70; P=0.016), higher positive end-expiratory pressure level [(5 .14 ±0.38)cm H2O vs (5.71 ±1.49)cm H2O vs (9.00 ±3.61) cm H2O, P=0.048], higher ICU mortality (4.0%vs 31.2%vs 50.0%, P=0.014) and hospital mortality (8.0% vs 31.2% vs 50.0%, P=0.042).Receiver operating curve analysis showed that area under the receiver operating curve was 0.650 ±0 .059 (95%CI 0.533~0.766, P=0.032) for AECC criteria and 0.665 ±0.060 (95%CI 0.548~0.781, P=0.018) for Berlin criteria in predicting ICU mortality.Conclusion Both AECC and Berlin criteria can stratify acute lung injury or ARDS patients by ventilator index and clinical outcomes.Berlin criteria may well guide clinical practice and scientific research due to its more accurate staging of ARDS.