外科危重患者合并急性呼吸衰竭139例回顾性分析

Acute respiratory failure in surgery intensive care unit:a retrospeetive analysis of 139 cases

目的探讨外科危重患者发生急性呼吸衰竭的病因及死亡危险因素,总结分析临床治疗的有效方法。方法2006-2007年上海交通大学附属仁济医院外科重症监护室外科危重住院围术期合并急性呼吸衰竭患者139例,分为死亡组(45例)和生存组(94例),从抗感染治疗、机械辅助通气、液体管理、营养支持方面进行回顾性比较。结果肺源性疾病引起的急性呼吸衰竭占61.9%。病例来源以普外科(50.4%)和胸外科(29.5%)为主。多脏器功能衰竭(χ2=13.469)、脓毒症(χ2=18.169)、肺部感染(χ2=24.861)与急性呼吸衰竭的预后相关(P值均=0.000)。死亡组中无创通气构成比及时间均显著低于生存组(P值均<0.05),生存组每日进量和每日液体净量均显著少于死亡组(P值均<0.05),生存组早期采用肠内营养的构成比显著高于死亡组(P<0.01)。结论外科危重患者急性呼吸衰竭可由全身多种疾病引起,当合并其他疾病时死亡风险进一步增高。应采取积极治疗原发病、控制感染、科学的机械通气辅助策略、严格液体管理、早期营养支持等综合方案治疗危重患者急性呼吸衰竭。

Objective To investigate the etiopathogeneses, outcomes and risk factors of death in patients with acute respiratory failure（ARF） in surgery intensive care unit （SICU） and to analyze the efficacy of medical treatments. Methods Clinical data from ARF 139 patients, who were hospitalized in SICU of our hospital from 2006 to 2007, were retrospectively analyzed. The patients were divided into two groups： death group and survival group. The impacts of various therapy methods, including anti-infection, airway management, mechanical ventilation, fluid-management, nutritional support, were compared between the two groups. Results Pulmonary disease was the major cause of ARF （61.9%） and 50.4% patients received abdominal surgery and 29.5% patients received thoracic surgery. Logistic regression analysis showed that there were significant correlation between multiple organ dysfunction syndrome （ Х^2 = 13. 469, P = 0. 000 ）, sepsis （ Х^2 = 18. 169, P = 0. 000 ）, pneumonia （ X^2 = 24. 861, P = 0. 000） and prognosis of ARF. The application of noninvasive mechanical ventilation, optimal fluid management and early nutritional support significantly improved the survival of ARF patients. Conclusion Pa- tients with acute respiratory failure in SICU were mainly caused by lung diseases. Treatment strategies focusing on primary disease, infection control, mechanical ventilation, optimal fluid management, and early nutritional support can improve the survival of these critically ill patients with acute respiratory failure.