急性呼吸窘迫综合征13例死亡因素分析

The Analysis of Death Factors in 13 Patients with ARDS

了解ＡＲＤＳ病死率与各种因素的关系。方法：对我院近年１３例ＡＲＤＳ患者回顾性分析，诊断标准符合欧美标准。采用机械通气ＰＥＥＰ及ＮＯ吸入治疗。结果：本组患者平均年龄４９±２０，病死率６１５％，其中年龄大于５５岁的病死率为５／６（８３％），小于５５岁病死率为３／７（４３％）。吸入ＮＯ治疗的ＡＲＤＳ患者，病死率为３／７（４３％），无吸入ＮＯ治疗的病死率为５／６（８３％）。原发病为感染性疾病的病死率为８／１０（８０％），原发病为创伤的病死率为０／３（０％）。４个器官衰竭患者的病死率为６／６（１００％），３个器官衰竭患者的病死率为２／４（５０％０），２个器官衰竭患者的病死率为２／５（４０％）。结论：以上结果表明年龄大于５５岁的ＡＲＤＳ患者，原发病为感染性疾病的ＡＲＤＳ患者，３个以上器官衰竭的ＡＲＤＳ患者病死率明显增加，而保持较低的ＰＡＷＰ及早期吸入ＮＯ治疗。

Objective:To examine the relationship between certain risk factors and mortality in ARDS. Methods:The diagnosis in 13 ARDS cases, aged 20～83 years (average 49±20),10 male and 3 female, was based on The American-European Consensus Conference on ARDS (1992). The principle of management included: (1) Using Swan-Ganz Catheters for hemodynamic monitoring and support; (2) fluid and electrolyte balance; (3) using PEEP for ventilatory support; (4) Using antibiotics to prevent infection; (5) nitric oxide (NO) inhalation with 20～40 ppm for 0.5-2 hr in 6 cases. Results:Mortality was 61.5% (8/13).It was increased in patient in age>55(83% vs 43%), non NO inhalation (83% vs 43%), infection (83%, 8/10), 4 organs failure (100%), 3 organs failure 50% 2/4), PAWP>12 mmHg 75% (6/8) vs 40%(2/5). Conclusion:ARDS mortality is significantly higher in patients older than 55yr, with primary infection, with more than three organs failure. However, lowing PAWP and NO inhalation in earlier stage may decrease the mortality of ARDS.