急性肺损伤／急性呼吸窘迫综合征患者预后因素分析

Analysis of factors of impacting on the outcomes of patients with ALI/ARDS

目的研究影响急性损伤／急性呼吸窘迫综合征（acute lung injury／acute respiratory distress syndrome，ALI／ARDS）患者的预后因素。方法回顾分析中国医学科学院肿瘤医院ICU2005年1月至2006年12月间全部63例ALI／ARDS患者的资料。根据病情转归分为生存组（n=39）和死亡组（n=24）。根据病因分为肺外型和肺内型。结果ALI／ARDS发病率为5．2％（63／1201）。单因素分析发现生存组和死亡组之间机械通气时间（P=0．028）、血肌酐水平（P=0．031）、氧合指数（P=0．023）、转入时APACHEH评分（P〈0．001）和转入时SOFA评分（P〈0．001）差异具有统计学意义。多因素分析发现仅转入时APACHEⅡ评分影响预后（P=0．015，OR：3．809，95％CI：1．295～11．203）。肺内型和肺外型两组之间1年生存率差异无统计学意义（63．9％VS．55．4％，P=0．982）。ARDS组和ALI组两组之间1年生存率差异具有统计学意义（44．9％vs．88．9％，P=0．008）。结论转入时患者A．PACHEⅡ评分是判断ALI／ARDS患者预后的独立危险因素，ALI／ARDS的病因不影响ALI／ARDS患者的生存。

Objective To investigate the factors influencing the outcomes of patients with ALI/ARDS. Method Data of 63 patients with ALI/ARDS in ICU, Cancer Hospital, Chinese Academy of Medical Science, from January 2005 to December 2006, were retrospectively analyzed. Patients were divided into survivor group （ n = 39） and non-survivor group （ n = 24） according to different outcomes, and equally, patients were classified in the respect of different causes as pulmonary origin and extra-pulmonary origin. Results The incidence of ALI/ARDS was 5.2 % （63/1201） in ICU. The univariate analysis showed that the differences in the length of mechanical ventilation （ P = 0.028）, blood creatinine level （ P = 0.031）, oxygenation index （ P = 0.023）, between survivor group and non-survivor group. In addition, the differences in acute physiology and chronic health evaluation n （A- PACHE Ⅱ ） scores and sequential organ failure assessment （SOFA） on the admission day were significant between survival group and non-survival group （P 〈 0.001, respectively）. Logistic regression analysis showed that A- PACHE Ⅱ scores was the only independent predictor of the mortality in patients with ALI/ARDS （P = 0.015, OR： 3.809, 95% CI：1.295 - 11.203）. There was no significant difference in one-year survival between pulmonary origin cause of ALI/ARDS group and extra-pulmonary origin cause of ALI/ARDS group （63.9% vs. 55.4%）. There was significant difference in one-year survival between ARDS and ALI group（44.9% vs. 88.9%, P 〈0.05）. Conclusions APACHE Ⅱ seores onthe admission day of patients is the only independent predictor of the mortality in patients with ALI/ARDS, whereas the underlying cause of ALI/ARDS does not matter to the survival of patients.