手术后急性呼吸窘迫综合征发生及预后相关因素的研究

Related factors of occurrence and prognosis of acute respiratory distress syndrome after surgery

目的探讨手术后患者急性呼吸窘迫综合征(ARDS)预后的相关因素。方法将5年内发生ARDS的手术后患者纳入研究,按照30d后的生存情况分为病死组和生存组。对患者性别、年龄、合并症、是否吸烟、体重指数、手术时间、术中失血量及输血、补液量、APACHEⅡ评分、氧合指数(PaO2/FiO2)、确诊前住院天数、血清白蛋白、尿素氮、肌酐、血小板、白细胞等因素与其发生及预后进行分析。将单因素分析差异有统计学意义的变量进行多因素logistic回归分析。结果 75例ARDS患者病死21例,生存54例。单因素分析结果显示:2组年龄、PaO2/FiO2、APACHEⅡ评分、白蛋白和血小板差异均有统计学意义(P<0.05);logistic回归分析结果显示:PaO2/FiO2、年龄和APACHEⅡ评分与病死率高度相关(P<0.05)。结论 PaO2/FiO2、年龄和APACHEⅡ评分是影响预后的高危因素。

Objective To investigate the related factors of occurrence and prognosis of acute respiratory distress syndrome （ARDS） after surgery. Methods The patients who developed ARDS after operations from January 2005 to December 2009 in our department were enrolled in the study. The patients were divided into survival group and death group according to the survival 30 days after ARDS. The relationship between the factors such as sex, age, complications, smoking, body mass index （BMI） , duration of operation, amount of blood loss, amount of blood transfusion and infusion, APACHE II score, oxygenation index （ PaO2/FiO2 ）, length of hospital stay before diagnosis, serum albumin, BUN, Cr, Plt, WBC and the occurrence and prognosis were analyzed. Univariate analysis and multivariate logistic regression analysis were used to examine the relations between the risk factors and the occurrence and prognosis. Results There were 21 nonsurvivors and 54 survivors in 75 ARDS patients. Single factor analysis revealed that there was significant difference in age, oxygenation index, APACHE II score, albumin and Ph in both groups （ P 〈 0.05 ）. Logistic regression analysis revealed that oxygenation index, age and APACHE II score were highly correlated with mortality. Conclusion Oxygenation index, age and APACHE II score are high risk factors for prognosis.