儿科ICU中急性呼吸窘迫综合征的临床回顾性分析

A review of acute respiratory distress syndrome in pediatric ICU

目的总结我院儿科重症监护室中(PICU)收治的急性呼吸窘迫综合征(ARDS)患儿的临床流行病学特点,以期提高ARDS的诊治水平。方法回顾性总结2002年6月～2004年2月我院PICU的14例确诊为ARDS患儿的特点。结果ARDS的发病率为2.3%。诱发ARDS的因素有体外循环、肺炎、脓毒症、休克等,其中以体外循环为最多见(占发病人数的42.9%)。确诊时急性肺损伤指数和PaO2FiO2分别为(3.2±0.6)和(86.5±23.8)。机械通气时最高吸气峰压和呼气终末正压分别是(33.8±8.4)cmH2O、(8.3±4.8)cmH2O。ARDS平均住院时间为18.1d,占PICU危重病人总住院时间的21.2%。因多器官功能衰竭、呼吸衰竭死亡6例(病死率42.9%),占PICU死亡总数的21.5%。结论积极去除高危因素预防ARDS、探讨ARDS更有效的治疗方法、降低病死率仍是我们今后工作的重点。

Objective To investigate the clinical epidemiology character of ARDS in PICU of our hospital and to improve treatment level of ARDS.Methods To summarize the character of patients diagnosed as ARDS and admitted to our PICU from June 2002 to Feb 2004.Results The incidence of ARDS in our PICU was 2.3%.Cardio-pulmonary bypass,severe pneumonia,sepsis and shock were predisosing risk factors.Cardio-pulmonary bypass was the most common fator (accounting for 42.9%).The acute lung injury index and PaO_2/FiO_2 on diagnosis of ARDS were (3.2±0.6) and (86.5±23.8) respectively.PIP and PEEP on ventilation were (33.8±8.4) cmH_2O and (8.3±4.8) cmH_2O.The inhospital duration of ARDS was 18.1 days accounting for 21.2% of total staying days of severe patients in PICU.Six cases were died of MOSF or respiratory failue (the mortality rate was 42.9%) which accounting for 21.5% of the dead patients at the same time in our unit.Conclusion Erasing the risk factors to prevent ARDS and exploring more effective therapy are the highlight of our work in future.