急性呼吸窘迫综合征患者病死危险因素的调查

Investigation of acute respiratory distress syndrome:predictors of mortality and clinical therapeutic strategies

目的：调查急性呼吸窘迫综合征（ＡＲＤＳ）的病死率及危险因素。方法：回顾性调查北京协和医院ＩＣＵ１９９１年～１９９６年的２１４例ＡＲＤＳ患者，进行单因素和多因素Ｌｏｇｉｓｔｉｃ回归分析。结果：ＡＲＤＳ总病死率为５１．４０％。以年龄（＞６０岁）、性别（男）、ＡＰＡＣＨＥⅡ评分（＞２０分）对病死率进行调整，调整后６年间病死率均无显著变化。多因素分析显示ＡＲＤＳ病死危险因素有：①肺外器官功能衰竭；②免疫功能低下；③慢性疾病史；④感染性休克；⑤ＡＰＡＣＨＥⅡ评分。未发生肺外器官功能衰竭者全部存活，而发生肺外器官功能衰竭者，病死率５７．２９％，衰竭器官数目越多，病死率越高。机械通气支持技术的进步使ＡＲＤＳ患者死于顽固性低氧血症仅１２．７３％；直接死于感染性休克者占４８．１８％。结论：该院９０年代以来ＡＲＤＳ病死率并未下降；

Objective:To study the mortality of acute respiratory distress syndrome (ARDS) and risk factors in Chinese ARDS patients.Methods:We retrospectively studied 214 ARDS patients in ICU of Peking Union Medical College Hospital from 1991 to 1996.Stepwise logistic regression analysis was used to identify variables associated with hospital mortality.Results:The overall mortality of ARDS was 51 40%,the mortality rate adjusted for age,gender,and acute physiology and chronic health evaluation (APACHE)Ⅱ score respectively showed no significant changes during the 6 years.Multivariate analysis identified the following risk factors:nonpulmonary organ failure,immunocompromise,chronic disease,septic shock,and APACHEⅡ score (>20).The mortality of patients with and without nonpulmonary organ failure were 57 29% and 0,respectively.The mortality rate was elevated along with increase in failing organs.Almost half (48 18%) of ARDS patients died of septic shock,while only 12 73% died of refractory hypoxemia.Conclusions:The mortality of ARDS shows no trend to decline since 1990s in this hospital.Prevention of septic shock and multiple organ failure may play a key role in the improvement of prognosis of ARDS patients.