急性呼吸窘迫综合征患儿的死亡相关因素分析

Clinical Study of Mortality and Risk Factors in Children with Acute Respiratory Distress Syndrome

目的探讨影响急性呼吸窘迫综合征(ARDS)患儿死亡的相关因素。方法收集了符合ARDS诊断标准的患儿共25例,检测血清SP-A、IL-8、IL-10、基础皮质醇水平,记录呼吸机使用参数、机械通气时间及住院时间,并进行统计学分析。结果死亡组患儿血清SP-A、IL-8、IL-10水平、机械通气最高PEEP显著高于存活组ARDS患儿,基础皮质醇水平、最低PaO2/F iO2显著低于存活组患儿。存活组患儿住院时间、机械通气时间显著长于死亡患儿。肺内源性ARDS机械通气最高PEEP显著高于肺外源性ARDS患儿,最低PaO2/F iO2显著低于肺外源性ARDS。ARDS患儿预后与血清IL-10水平、SP-A水平、住院时间有关,是影响ARDS死亡的主要危险因素。结论调节炎性/抗炎的平衡,肺表面活性蛋白的替代,改善肾上腺皮质功能不全,并结合先进的呼吸机治疗技术,从多方面入手综合治疗ARDS有助于改善预后。

Objective To investigate of mortality and risk factors in children with acute respiratory distress syndrome（ARDS）.Methods We collected 25 children meeting the diagnostic criteria for ARDS.The serum SP-A,IL-8,IL-10 and basic cortisol levels were detected;the mechanical ventilation parameters and time and hospital stay were also recorded.All data were statistically analyzed.Results Serum SP-A,IL-8,IL-10 and highest level of positive end expiratory pressure（PEEP） in death patients were higher than those of alive children with ARDS;but the basic cortisols level and the lowest PaO2/FiO2 level made a contrary change.The mechanical ventilation time and hospital stay of the live patients were significantly longer than that of death ones.The highest level of PEEP in patients with pulmonary acute respiratory distress syndrome（ARDSp） was higher than that in patients with extrapulmonary ARDS（ARDSexp）;while the lowest level of PaO2/FiO2 of ARDSp were showed a contrary tendency.The levels of serum SP-A and IL-10 and the hospitalization time were the main risk factors for death,and closely correlated to the prognosis of children with ARDS.Conclusion To Adjust the balance of inflammatory/anti-inflammatory,supplement lung surfactant-associated protein,improve adrenocortical function,and adopt the technology of mechanical ventilation can improve the prognosis of pediatric ARDS.