严重创伤合并急性肺损伤恶化进展至急性呼吸窘迫综合征的临床危险因素分析

Analysis of clinical risk factors in progression from acute lung injury to acute respiratory distress syndrome in severe trauma patients

目的研究影响严重创伤合并急性肺损伤恶化进展为急性呼吸窘迫综合征的潜在危险因素。方法回顾性分析严重创伤患者375例，通过单因素和多因素逻辑回归分析法对20个潜在影响急性肺损伤恶化进展的危险因素进行研究。结果所有严重创伤合并急性肺损伤患者纳入研究，分析得出6个影响急性肺损伤进展为急性呼吸窘迫综合征的危险因素是：脓毒症、创伤持续时间、APACHEⅡ评分、弥漫性血管内凝血（DIC）、胃肠返流、高龄；同时发现这些特定的危险因素对不同的分层患者人群具有不同的影响程度。结论脓毒症、DIC和创伤持续时间对急性肺损伤恶化进展为急性呼吸窘迫综合征的影响是始终贯穿于整个治疗期；胃肠返流和APACHEⅡ评分对病情进展的预测仅仅存在于创伤后的早期阶段；由于严重的创伤性打击和肺功能的衰退，高龄仍旧是影响急性肺损伤进展的独立危险因素。具备这些危险因素的患者必须尽可能早的接受积极治疗以阻止进一步恶化。

Objectives To investigate the potential risk factors of affecting progression from acute lung injury （ALI） to acute respiratory distress syndrome in severe trauma population. Methods Twenty potential risk factors of affecting progression of acute lung injury were examined by univariate and multivariate logistic analyses among the severe trauma patients in a retrospective study. Results All of 375 specially severe trauma patients with ALl were included for analysis. The six risk factors that affected the progression from acute lung injury to acute respiratory distress syndrome were sepsis, duration of trauma, APACHE Ⅱ score, DIC, aspiration of gastric contents, and advanced age. Specific risk factors also affected different patient subpopulations at different degrees. Conclusion Impact of sepsis, DIC and duration of trauma that predict progression of ALl exists throughout the entire treatment period while aspiration of gastric contents and APACHE Ⅱ score might affect aggravation of ALI only during the early period; due to deterioration of pulmonary function and severely traumatic injury, advanced age is still an independent risk factor; patients with these risk factors need aggressive supportive cares as early as possible in order to prevent further aggravations.