外科重症监护病房非心脏术后患者急性肺损伤/急性呼吸窘迫综合征特点及影响预后的多因素分析

Clinical profiles and prognostic risk factors in ALI/ARDS patients after non-cardiac operations in SICU

目的回顾分析外科重症监护病房(SICU)非心脏术后住院患者的临床资料,以观察非心脏手术后患者急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的发病情况及预后影响因素。方法2006年9月至2007年8月连续收入解放军总医院外科重症监护病房的105名非心脏手术术后患者纳入本研究。其中男62名,女43名;年龄(51.0±18.1)岁。沿用中华医学会重症医学分会(2006年)提出的ALI/ARDS诊断标准,所有观察病例按照入住SICU期间的最低氧合指数水平分为3组:氧合指数正常组,ALI组,ARDS组。分别比较各病例组年龄,体重,体重指数,ICU停留时间,以及患者住ICU期间以及转出ICU后30d内患者总死亡率,术中出血量与输液量。并应用Logistic回归分析以上各因素对ALI/ARDS患者总死亡率的影响。结果3组患者间年龄、体重和体重指数比较有显著性统计差异,发生ARDS组患者体重最重,体重指数最高。ARDS组在ICU停留时间明显高于其他2组。3组患者总死亡率无显著统计差异。各组患者中,术中出血量和液体入量无显著差异。Logistic回归分析显示,在发生ALI/ARDS的SICU患者中,年龄是影响患者预后的独立因素。高龄ALI/ARDS患者更容易发生死亡。结论老年、体重较重的患者更容易在术后发生ALI/ARDS,应加强此类高危患者的围术期管理,从而降低外科术后ALI/ARDS发病率,减少发病患者的死亡率。

Objective To retrospectively investigate the clinical characters of acute lung injury / acute respiratory distress syndrome （ALI/ARDS） patients in surgical intensive care unit （SICU） after non cardiac operations in order to clarify the incidences and related prognostic risk factors. Methods The clinical data of 105 patients after non- cardiac operations who were admitted to SICU from September 2006 to August 2007 were reviewed. The patients were divided into three groups according to the guideline of ALI/ARDS revised by the Chinese Society of Critical Care Medicine （CCCM, 2006）： PaCO2/FiO2 index normal group, ALI group and ARDS group. Patients＇ age, weight, body mass index （BMI）, time of staying in SICU, mortality in SICU and 30 days after discharged from SICU, bleeding in operation, total intravenous fluid administration in operation were compared among different groups. The logis tic regression analysis was performed to indentify the factors influencing the prognosis of ALI/ARDS patients. Results The age, weight and BMI of patients were significantly different among the groups. Patients in ARDS group were heavier and had higher BMI than those in other groups; the time of staying in SICU was significantly prolonged. There were no significant differences in the mortality among three groups. Patients with ARDS or ALI were mostly from abdomen surgery department （including liver transplantation and gastroenteritic surgery）. The age was the inde- pendent factor that could influence the prognosis of ALI/ARDS patients. The elder patients had higher mortality than younger patients. Conclusion The elder or heavier patients were more susceptible to develop ALI/ARDS. Management of such high risk patients during peri operaional period should be strengthened in order to decrease the morbidity of AL1/ARDS and mortality after operation.