重症胸外伤合并成人呼吸窘迫综合征的高危因素分析

High risk factors related to adult respiratory distress syndrome following thoracic trauma

目的 探讨胸外伤并发成人呼吸窘迫综合征 (Adultrespiratorydistresssyndrome ,ARDS)的高危因素。方法 回顾分析近 2 0年来收治的 370例胸外伤合并多发伤的临床资料 ,对其中并发ARDS患者进行单因素和COX多因素回归分析 ,推测可能发生ARDS的高危因素。结果 本组ARDS发生率为 8.92 % ,单因素分析影响胸外伤并发ARDS的主要因素为年龄、血压、肺部并存病、ISS值、呼吸频率、肺挫伤、氧分压、二氧化碳分压 (P <0 .0 1) ,血气胸、腹腔脏器伤 (P <0 .0 5 )。多因素分析影响胸外伤并发ARDS的独立高危因素为 :高龄、肺部并存病、休克、ISS值、呼吸困难、肺挫伤、动脉血氧分压、动脉血二氧化碳分压。结论 对具有高危因素的患者严密监测血压、血气、呼吸。适时应用机械通气 ,降低ARDS发生率。

Objective To analyze the high risk factors of adult respiratory distress syndrome (ARDS) complicating thoracic trauma.Methods Univariate and Cox multivariate regression analysis of 370 patients with severe thoracic trauma hospitalized in the past 20 years,was made to infer the high risk factors of ARDS.Results The incidence of ARDS was 8.92% .Univariate analysis showed that the major factors related to ARDS following thoracic injury were age,systolic pressure,coexisting pulmonary disease,ISS value,respiratory rate,pulmonary contusion,PaO 2,PaCO 2 (P<0.01),hemopneumothorax,abdominal injury (P<0.05).The multivariate analysis demonstrated that the independent high risk factors were elder age,coexisting pulmonary diseases, shock,ISS value,dyspnea,pulmomary contusion, PaO 2,and PaCO 2.Conclusions It is necessary to monitor the systolic pressure ,blood-gas and respiraton of the patients with high risk factors.Mechanical ventilation should be used timely to reduce the occurrence rate of ARDS.