目的：探讨阳明腑实证合并急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）患者的死亡危险因素。方法采用前瞻性研究方法，选择2009年8月至2013年7月天津市南开医院、北京中医药大学东直门医院、天津医科大学总医院、大连医科大学附属第一医院、江苏省无锡市第三人民医院5家医院入选的符合阳明腑实证表现的腹部疾病合并ALI/ARDS的206例患者，按重症加强治疗病房（ICU）住院期间存活情况分为死亡组和存活组。记录两组患者的性别、年龄，纳入观察后第一个24 h急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、有创机械通气时间、血管活性药物使用情况、手术比例、ICU住院时间、是否应用连续性肾脏替代治疗（CRRT）、输血比例、C-反应蛋白（CRP）、乳酸/甘露醇（L/M）比值、累及器官数、氧合指数（PaO2/FiO2）、乳酸及血肌酐（SCr）水平；采用logistic回归分析筛选患者死亡的独立危险因素。结果阳明腑实证合并ALI/ARDS患者的原发病主要为重症急性胰腺炎（SAP）124例，占60.19%；ICU住院期间存活171例，死亡35例，病死率为16.99%。对两组患者的各项危险因素进行单因素分析显示，与存活组比较，死亡组患者的年龄大（岁：57.26±16.23比48.07±13.48，t＝3.544，P＝0.000），APACHEⅡ评分高（分：20.83±9.73比12.61±6.63，t＝4.777，P＝0.000），机械通气时间长（d：10.97±7.71比6.91±2.48，t＝2.555， P＝0.015），累及器官多（个：3.11±1.21比1.60±1.34，t＝6.222，P＝0.000），PaO2/FiO2低〔mmHg（1 mmHg＝0.133 kPa）：218.56±64.90比244.58±85.10，t＝-2.024，P＝0.044〕，ICU住院时间长（d：14.33±10.81比9.11±7.37，t＝2.600，P＝0.010），CRRT使用率高〔28.57%（10/35）比15.20%（26/171），χ2＝3.968，P＝0.046〕、血管活性药物使用率高〔28.57%（10/35）比12.28%（21/171），χ2＝6.511，P＝0.011〕，输血比例大〔42.86%（15/35）比23.39%（40/171），χ2＝7.042，P＝0.008〕；两组性别、手术比例、CRP、L/M比值、乳酸、SCr比较差异均无统计学意义（均P＞0.05）。多因素logistic回归分析显示：年龄〔优势比（OR）＝0.938，95%可信区间（95%CI）＝0.898～0.980，P＝0.004〕、APACHEⅡ评分（OR＝0.914，95%CI＝0.839～0.996，P＝0.041）、累及器官数≥3个（OR＝0.223，95%CI＝0.066～0.754，P＝0.016）、PaO2/FiO2（OR＝0.990，95%CI＝0.982～0.998，P＝0.015）为患者死亡的独立危险因素。结论年龄、APACHEⅡ评分、累及器官数≥3个、PaO2/FiO2对判断阳明腑实证合并ALI/ARDS患者的预后有一定意义，对合并死亡危险因素的患者应给予更为密切的监测和积极的治疗。were enrolled in the intensive care units (ICUs) of the following five hospitals： Tianjin Nankai Hospital, Dongzhimen Hospital Affiliated to Beijing Traditional Chinese Medicine University, General Hospital of Tianjin Medical University, the First Affiliated Hospital of Dalian Medical University, and Wuxi Third People's Hospital in Jiangsu Province. According to the mortality occurring in ICU, the patients were divided into death group and survival group. The gender, age, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score within the first 24 hours after admission, the length of invasive mechanical ventilation, usage of vasoactive agents, ratio of operative intervention, the length of stay in ICU, application of continuous renal replacement therapy (CRRT), amount of blood transfusion, the level of C-reactive protein (CRP), lactulose/mannitol (L/M) ratio, the number of organs with dysfunction, oxygenation index (PaO2/FiO2), levels of lactate and serum creatinine (SCr) of both groups were recorded. Logistic regression analysis was used to look for the independent risk factors of death of patients.Results There were 124 cases with severe acute pancreatitis (SAP), which was the most common disease with manifestation of Yangming Fushi syndrome combined with ALI/ARDS, accounting for 60.19% of all the patients. During the period of hospitalization in ICU,171 patients survived and 35 died, and the mortality rate was 16.99%. The risk factors of the two groups were analyzed by variable analysis, and it was shown that compared with those in survival group, the age (years：57.26±16.23 vs.48.07±13.48,t =3.544, P =0.000), APACHEⅡ score (20.83±9.73 vs.12.61±6.63,t =4.777,P =0.000), the length of invasive mechanical ventilation (days：10.97±7.71 vs.6.91±2.48,t =2.555,P =0.015) and the number of dysfunction organs (3.11±1.21 vs.1.60±1.34,t =6.222,P =0.000) in death group were significantly higher. The level of PaO2/FiO2[mmHg (1 mmHg =0.133 kPa)：218.56±64.90 vs.244.58±85.10,t =-2.024,P =0.044] in the death group was significantly lower than that of the survival group, while the length of ICU stay (days：14.33±10.81 vs.9.11±7.37,t =2.600, P =0.010), the usage rates of CRRT [28.57%(10/35) vs.15.20%(26/171),χ2=3.968,P =0.046], vasoactive agents [28.57%(10/35) vs.12.28%(21/171),χ2=6.511,P =0.011], and blood transfusion ratio [42.86%(15/35) vs.23.39%(40/171),χ2=7.042,P =0.008] were all obviously higher in the death group than those in the survival group. There were no statistically significant differences in gender, number of operation, the levels of CRP, L/M ratio, lactate and SCr between the two groups (allP>0.05). Multivariate logistic regression analysis showed that age [odds ratio (OR)=0.938,95% confidence interval (95%CI)=0.898-0.980,P =0.004], APACHEⅡ score (OR =0.914,95%CI =0.839-0.996,P =0.041), the number of dysfunction organs≥3(OR =0.223,95%CI =0.066-0.754, P =0.016), and the level of PaO2/FiO2(OR =0.990,95%CI =0.982-0.998,P =0.015) were independent risk factors for mortality.Conclusions The age, APACHEⅡ score, number of dysfunction organs≥3 and the level of PaO2/FiO2 are of significance in predicting the prognosis of patients with Yangming Fushi syndrome combined with ALI/ARDS. Patients with risk factors of high mortality should be more carefully monitored and treated aggressively.
目的：探討暘明腑實證閤併急性肺損傷/急性呼吸窘迫綜閤徵（ALI/ARDS）患者的死亡危險因素。方法採用前瞻性研究方法，選擇2009年8月至2013年7月天津市南開醫院、北京中醫藥大學東直門醫院、天津醫科大學總醫院、大連醫科大學附屬第一醫院、江囌省無錫市第三人民醫院5傢醫院入選的符閤暘明腑實證錶現的腹部疾病閤併ALI/ARDS的206例患者，按重癥加彊治療病房（ICU）住院期間存活情況分為死亡組和存活組。記錄兩組患者的性彆、年齡，納入觀察後第一箇24 h急性生理學與慢性健康狀況評分繫統Ⅱ（APACHEⅡ）評分、有創機械通氣時間、血管活性藥物使用情況、手術比例、ICU住院時間、是否應用連續性腎髒替代治療（CRRT）、輸血比例、C-反應蛋白（CRP）、乳痠/甘露醇（L/M）比值、纍及器官數、氧閤指數（PaO2/FiO2）、乳痠及血肌酐（SCr）水平；採用logistic迴歸分析篩選患者死亡的獨立危險因素。結果暘明腑實證閤併ALI/ARDS患者的原髮病主要為重癥急性胰腺炎（SAP）124例，佔60.19%；ICU住院期間存活171例，死亡35例，病死率為16.99%。對兩組患者的各項危險因素進行單因素分析顯示，與存活組比較，死亡組患者的年齡大（歲：57.26±16.23比48.07±13.48，t＝3.544，P＝0.000），APACHEⅡ評分高（分：20.83±9.73比12.61±6.63，t＝4.777，P＝0.000），機械通氣時間長（d：10.97±7.71比6.91±2.48，t＝2.555， P＝0.015），纍及器官多（箇：3.11±1.21比1.60±1.34，t＝6.222，P＝0.000），PaO2/FiO2低〔mmHg（1 mmHg＝0.133 kPa）：218.56±64.90比244.58±85.10，t＝-2.024，P＝0.044〕，ICU住院時間長（d：14.33±10.81比9.11±7.37，t＝2.600，P＝0.010），CRRT使用率高〔28.57%（10/35）比15.20%（26/171），χ2＝3.968，P＝0.046〕、血管活性藥物使用率高〔28.57%（10/35）比12.28%（21/171），χ2＝6.511，P＝0.011〕，輸血比例大〔42.86%（15/35）比23.39%（40/171），χ2＝7.042，P＝0.008〕；兩組性彆、手術比例、CRP、L/M比值、乳痠、SCr比較差異均無統計學意義（均P＞0.05）。多因素logistic迴歸分析顯示：年齡〔優勢比（OR）＝0.938，95%可信區間（95%CI）＝0.898～0.980，P＝0.004〕、APACHEⅡ評分（OR＝0.914，95%CI＝0.839～0.996，P＝0.041）、纍及器官數≥3箇（OR＝0.223，95%CI＝0.066～0.754，P＝0.016）、PaO2/FiO2（OR＝0.990，95%CI＝0.982～0.998，P＝0.015）為患者死亡的獨立危險因素。結論年齡、APACHEⅡ評分、纍及器官數≥3箇、PaO2/FiO2對判斷暘明腑實證閤併ALI/ARDS患者的預後有一定意義，對閤併死亡危險因素的患者應給予更為密切的鑑測和積極的治療。were enrolled in the intensive care units (ICUs) of the following five hospitals： Tianjin Nankai Hospital, Dongzhimen Hospital Affiliated to Beijing Traditional Chinese Medicine University, General Hospital of Tianjin Medical University, the First Affiliated Hospital of Dalian Medical University, and Wuxi Third People's Hospital in Jiangsu Province. According to the mortality occurring in ICU, the patients were divided into death group and survival group. The gender, age, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score within the first 24 hours after admission, the length of invasive mechanical ventilation, usage of vasoactive agents, ratio of operative intervention, the length of stay in ICU, application of continuous renal replacement therapy (CRRT), amount of blood transfusion, the level of C-reactive protein (CRP), lactulose/mannitol (L/M) ratio, the number of organs with dysfunction, oxygenation index (PaO2/FiO2), levels of lactate and serum creatinine (SCr) of both groups were recorded. Logistic regression analysis was used to look for the independent risk factors of death of patients.Results There were 124 cases with severe acute pancreatitis (SAP), which was the most common disease with manifestation of Yangming Fushi syndrome combined with ALI/ARDS, accounting for 60.19% of all the patients. During the period of hospitalization in ICU,171 patients survived and 35 died, and the mortality rate was 16.99%. The risk factors of the two groups were analyzed by variable analysis, and it was shown that compared with those in survival group, the age (years：57.26±16.23 vs.48.07±13.48,t =3.544, P =0.000), APACHEⅡ score (20.83±9.73 vs.12.61±6.63,t =4.777,P =0.000), the length of invasive mechanical ventilation (days：10.97±7.71 vs.6.91±2.48,t =2.555,P =0.015) and the number of dysfunction organs (3.11±1.21 vs.1.60±1.34,t =6.222,P =0.000) in death group were significantly higher. The level of PaO2/FiO2[mmHg (1 mmHg =0.133 kPa)：218.56±64.90 vs.244.58±85.10,t =-2.024,P =0.044] in the death group was significantly lower than that of the survival group, while the length of ICU stay (days：14.33±10.81 vs.9.11±7.37,t =2.600, P =0.010), the usage rates of CRRT [28.57%(10/35) vs.15.20%(26/171),χ2=3.968,P =0.046], vasoactive agents [28.57%(10/35) vs.12.28%(21/171),χ2=6.511,P =0.011], and blood transfusion ratio [42.86%(15/35) vs.23.39%(40/171),χ2=7.042,P =0.008] were all obviously higher in the death group than those in the survival group. There were no statistically significant differences in gender, number of operation, the levels of CRP, L/M ratio, lactate and SCr between the two groups (allP>0.05). Multivariate logistic regression analysis showed that age [odds ratio (OR)=0.938,95% confidence interval (95%CI)=0.898-0.980,P =0.004], APACHEⅡ score (OR =0.914,95%CI =0.839-0.996,P =0.041), the number of dysfunction organs≥3(OR =0.223,95%CI =0.066-0.754, P =0.016), and the level of PaO2/FiO2(OR =0.990,95%CI =0.982-0.998,P =0.015) were independent risk factors for mortality.Conclusions The age, APACHEⅡ score, number of dysfunction organs≥3 and the level of PaO2/FiO2 are of significance in predicting the prognosis of patients with Yangming Fushi syndrome combined with ALI/ARDS. Patients with risk factors of high mortality should be more carefully monitored and treated aggressively.
목적：탐토양명부실증합병급성폐손상/급성호흡군박종합정（ALI/ARDS）환자적사망위험인소。방법채용전첨성연구방법，선택2009년8월지2013년7월천진시남개의원、북경중의약대학동직문의원、천진의과대학총의원、대련의과대학부속제일의원、강소성무석시제삼인민의원5가의원입선적부합양명부실증표현적복부질병합병ALI/ARDS적206례환자，안중증가강치료병방（ICU）주원기간존활정황분위사망조화존활조。기록량조환자적성별、년령，납입관찰후제일개24 h급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분、유창궤계통기시간、혈관활성약물사용정황、수술비례、ICU주원시간、시부응용련속성신장체대치료（CRRT）、수혈비례、C-반응단백（CRP）、유산/감로순（L/M）비치、루급기관수、양합지수（PaO2/FiO2）、유산급혈기항（SCr）수평；채용logistic회귀분석사선환자사망적독립위험인소。결과양명부실증합병ALI/ARDS환자적원발병주요위중증급성이선염（SAP）124례，점60.19%；ICU주원기간존활171례，사망35례，병사솔위16.99%。대량조환자적각항위험인소진행단인소분석현시，여존활조비교，사망조환자적년령대（세：57.26±16.23비48.07±13.48，t＝3.544，P＝0.000），APACHEⅡ평분고（분：20.83±9.73비12.61±6.63，t＝4.777，P＝0.000），궤계통기시간장（d：10.97±7.71비6.91±2.48，t＝2.555， P＝0.015），루급기관다（개：3.11±1.21비1.60±1.34，t＝6.222，P＝0.000），PaO2/FiO2저〔mmHg（1 mmHg＝0.133 kPa）：218.56±64.90비244.58±85.10，t＝-2.024，P＝0.044〕，ICU주원시간장（d：14.33±10.81비9.11±7.37，t＝2.600，P＝0.010），CRRT사용솔고〔28.57%（10/35）비15.20%（26/171），χ2＝3.968，P＝0.046〕、혈관활성약물사용솔고〔28.57%（10/35）비12.28%（21/171），χ2＝6.511，P＝0.011〕，수혈비례대〔42.86%（15/35）비23.39%（40/171），χ2＝7.042，P＝0.008〕；량조성별、수술비례、CRP、L/M비치、유산、SCr비교차이균무통계학의의（균P＞0.05）。다인소logistic회귀분석현시：년령〔우세비（OR）＝0.938，95%가신구간（95%CI）＝0.898～0.980，P＝0.004〕、APACHEⅡ평분（OR＝0.914，95%CI＝0.839～0.996，P＝0.041）、루급기관수≥3개（OR＝0.223，95%CI＝0.066～0.754，P＝0.016）、PaO2/FiO2（OR＝0.990，95%CI＝0.982～0.998，P＝0.015）위환자사망적독립위험인소。결론년령、APACHEⅡ평분、루급기관수≥3개、PaO2/FiO2대판단양명부실증합병ALI/ARDS환자적예후유일정의의，대합병사망위험인소적환자응급여경위밀절적감측화적겁적치료。were enrolled in the intensive care units (ICUs) of the following five hospitals： Tianjin Nankai Hospital, Dongzhimen Hospital Affiliated to Beijing Traditional Chinese Medicine University, General Hospital of Tianjin Medical University, the First Affiliated Hospital of Dalian Medical University, and Wuxi Third People's Hospital in Jiangsu Province. According to the mortality occurring in ICU, the patients were divided into death group and survival group. The gender, age, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score within the first 24 hours after admission, the length of invasive mechanical ventilation, usage of vasoactive agents, ratio of operative intervention, the length of stay in ICU, application of continuous renal replacement therapy (CRRT), amount of blood transfusion, the level of C-reactive protein (CRP), lactulose/mannitol (L/M) ratio, the number of organs with dysfunction, oxygenation index (PaO2/FiO2), levels of lactate and serum creatinine (SCr) of both groups were recorded. Logistic regression analysis was used to look for the independent risk factors of death of patients.Results There were 124 cases with severe acute pancreatitis (SAP), which was the most common disease with manifestation of Yangming Fushi syndrome combined with ALI/ARDS, accounting for 60.19% of all the patients. During the period of hospitalization in ICU,171 patients survived and 35 died, and the mortality rate was 16.99%. The risk factors of the two groups were analyzed by variable analysis, and it was shown that compared with those in survival group, the age (years：57.26±16.23 vs.48.07±13.48,t =3.544, P =0.000), APACHEⅡ score (20.83±9.73 vs.12.61±6.63,t =4.777,P =0.000), the length of invasive mechanical ventilation (days：10.97±7.71 vs.6.91±2.48,t =2.555,P =0.015) and the number of dysfunction organs (3.11±1.21 vs.1.60±1.34,t =6.222,P =0.000) in death group were significantly higher. The level of PaO2/FiO2[mmHg (1 mmHg =0.133 kPa)：218.56±64.90 vs.244.58±85.10,t =-2.024,P =0.044] in the death group was significantly lower than that of the survival group, while the length of ICU stay (days：14.33±10.81 vs.9.11±7.37,t =2.600, P =0.010), the usage rates of CRRT [28.57%(10/35) vs.15.20%(26/171),χ2=3.968,P =0.046], vasoactive agents [28.57%(10/35) vs.12.28%(21/171),χ2=6.511,P =0.011], and blood transfusion ratio [42.86%(15/35) vs.23.39%(40/171),χ2=7.042,P =0.008] were all obviously higher in the death group than those in the survival group. There were no statistically significant differences in gender, number of operation, the levels of CRP, L/M ratio, lactate and SCr between the two groups (allP>0.05). Multivariate logistic regression analysis showed that age [odds ratio (OR)=0.938,95% confidence interval (95%CI)=0.898-0.980,P =0.004], APACHEⅡ score (OR =0.914,95%CI =0.839-0.996,P =0.041), the number of dysfunction organs≥3(OR =0.223,95%CI =0.066-0.754, P =0.016), and the level of PaO2/FiO2(OR =0.990,95%CI =0.982-0.998,P =0.015) were independent risk factors for mortality.Conclusions The age, APACHEⅡ score, number of dysfunction organs≥3 and the level of PaO2/FiO2 are of significance in predicting the prognosis of patients with Yangming Fushi syndrome combined with ALI/ARDS. Patients with risk factors of high mortality should be more carefully monitored and treated aggressively.
ObjectiveTo investigate the risk factors of patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) complicated with Yangming Fushi syndrome.Methods A prospective study was conducted. From August 2009 to July 2013, 206 patients with Yangming Fushi syndrome combined with ALI/ARDS were enrolled in the intensive care units ( ICUs ) of the following five hospitals: Tianjin Nankai Hospital, Dongzhimen Hospital Affiliated to Beijing Traditional Chinese Medicine University, General Hospital of Tianjin Medical University, the First Affiliated Hospital of Dalian Medical University, and Wuxi Third People's Hospital in Jiangsu Province. According to the mortality occurring in ICU, the patients were divided into death group and survival group. The gender, age, acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) score within the first 24 hours after admission, the length of invasive mechanical ventilation, usage of vasoactive agents, ratio of operative intervention, the length of stay in ICU, application of continuous renal replacement therapy ( CRRT ), amount of blood transfusion, the level of C-reactive protein ( CRP ), lactulose/mannitol ( L/M ) ratio, the number of organs with dysfunction, oxygenation index ( PaO2/FiO2 ), levels of lactate and serum creatinine ( SCr ) of both groups were recorded. Logistic regression analysis was used to look for the independent risk factors of death of patients. Results There were 124 cases with severe acute pancreatitis ( SAP ), which was the most common disease with manifestation of Yangming Fushi syndrome combined with ALI/ARDS, accounting for 60.19% of all the patients. During the period of hospitalization in ICU, 171 patients survived and 35 died, and the mortality rate was 16.99%. The risk factors of the two groups were analyzed by variable analysis, and it was shown that compared with those in survival group, the age ( years: 57.26±16.23 vs. 48.07±13.48, t = 3.544, P = 0.000 ), APACHE Ⅱ score ( 20.83±9.73 vs. 12.61±6.63, t = 4.777, P = 0.000 ), the length of invasive mechanical ventilation ( days: 10.97±7.71 vs. 6.91±2.48, t = 2.555, P = 0.015 ) and the number of dysfunction organs ( 3.11±1.21 vs. 1.60±1.34, t = 6.222, P = 0.000 ) in death group were significantly higher. The level of PaO2/FiO2 [ mmHg ( 1 mmHg = 0.133 kPa ): 218.56±64.90 vs. 244.58±85.10, t = -2.024, P = 0.044 ] in the death group was significantly lower than that of the survival group, while the length of ICU stay ( days: 14.33±10.81 vs. 9.11±7.37, t = 2.600, P = 0.010 ), the usage rates of CRRT [ 28.57% ( 10/35 ) vs. 15.20% ( 26/171 ), χ2 = 3.968, P = 0.046 ], vasoactive agents [ 28.57% ( 10/35 ) vs. 12.28% ( 21/171 ), χ2 = 6.511, P = 0.011 ], and blood transfusion ratio [ 42.86% ( 15/35 ) vs. 23.39% ( 40/171 ), χ2 = 7.042, P = 0.008 ] were all obviously higher in the death group than those in the survival group. There were no statistically significant differences in gender, number of operation, the levels of CRP, L/M ratio, lactate and SCr between the two groups ( all P > 0.05 ). Multivariate logistic regression analysis showed that age [ odds ratio ( OR ) = 0.938, 95% confidence interval ( 95%CI ) = 0.898-0.980, P = 0.004 ], APACHE Ⅱ score ( OR = 0.914, 95%CI = 0.839-0.996, P = 0.041 ), the number of dysfunction organs ≥ 3 ( OR = 0.223, 95%CI = 0.066-0.754, P = 0.016 ), and the level of PaO2/FiO2 ( OR = 0.990, 95%CI = 0.982-0.998, P = 0.015 ) were independent risk factors for mortality. Conclusions The age, APACHE Ⅱ score, number of dysfunction organs ≥ 3 and the level of PaO2/FiO2 are of significance in predicting the prognosis of patients with Yangming Fushi syndrome combined with ALI/ARDS. Patients with risk factors of high mortality should be more carefully monitored and treated aggressively.
