外科ICU中心ARDS/MODS救治分析

Experience on treatment of ARDS/MODS in surgical ICU center

目的:回顾性分析救治ARDS/MODS的基础资料,探讨中度高原地区患者诊治策略.方法:将1996/2007间收入ICU中心的688例危重急症病例按统一标准筛选出符合ARDS/MODS71例,根据ICU专业建设不同年份分为初建期1996/2000(A组,n=21),中期2001-01/2004-06(B组,n=22),近期2004-07/2007-11(C组,n=28),3组均按高海拔地区ARDS/MODS评分系统相关指标参数进行统计,比较3组入住ICU的APACHE,MODS总分、住ICU时间、上机时间和结果.结果:三个不同时期MODS多脏器指标参数、APACHE总分、MODS总分评估差异不明显(P>0.05),但住ICU时间、带机时间C组明显短于A组(P<0.05),死亡率明显低于A组和B组(P<0.05).结论:应重视MODS患者的多脏器功能监测及评分,早期机械通气支持是治疗MODS的关键性策略.

AIM： To retrospectively study the diagnosis and treatment outcome of acute respiratory distress syndrome and multiorgan dysfunction syndrome （ARDS/MODS） in surgical intensive care unit （ICU） for patients at moderate plateau. METHODS： The clinical data of 688 patients treated in surgical ICU from 1996 to 2007 were retrospectively analyzed. Among them ,71 patients complicated with ARDS/MODS after surgery were divided into 3 groups according to different time period： group A （from 1996 to 2000, n = 21 ）, group B （ from January 2001 to June 2004,n =22） and group C （from July 2004 to November 2007, n =28）. All data of ARDS/MODS in the 3 groups were collected and analyzed statistically. RESULTS： There was no significant difference in MODS parameters, total acute physiology and chronic health evaluation （APACHE） score and total MODS score among the 3 groups （ P 〉 0.05 ）. But the mean interval time from the diagnosis of ARDS/MODS to receiving the treatment of mechanical ventilation in surgical ICU and the mean mechanical ventilation time in group C were significant shorter than those in group A （ P 〈 0.05 ）, and the mortality rate in group C was markedly lower than that in group A and B （ P 〈 0.05 ）. CONCLUSION ： Paying attention to muhiorgan function monitoring and muhiorgan dysfunction scoring and early use of mechanical ventilator support are all important strategies for the patients with MODS.