急性呼吸窘迫综合征患者预后的危险因素分析

Clinical analysis of prognostic risk factors of acute respiratory distress syndrome

目的研究影响急性呼吸窘迫综合征(ARDS)患者预后的危险因素。方法回顾分析2008年1月至2011年1月145例ARDS患者资料,分为存活组(n=80)和死亡组(n=65)。分别从年龄、APACHEⅡ评分、SOFA评分、器官功能不全数目、脓毒症严重程度、肺源性与非肺源性ARDS等方面分析与患者预后的关系。结果单因素分析显示存活组和死亡组之间,年龄(P<0.001)、APACHEⅡ评分(P<0.001)、SOFA评分(P=0.003)、器官功能不全数目(P<0.001)、脓毒症严重程度(P<0.001)、肺源性与非肺源性ARDS(P=0.043)、是否应用抗凝剂(P=0.006)差异有统计学意义。多因素分析显示,APACHEⅡ评分(P=0.016,OR:1.095,95%CI:1.017～1.179)、脓毒症严重程度(P<0.001,OR:2.559,95%CI:1.609～4.072)、肺源性与非肺源性ARDS(P=0.033,OR:0.348,95%CI:0.131～0.920)影响预后。结论 APACHEⅡ评分、脓毒症严重程度、ARDS诱发因素是影响ARDS患者预后的独立危险因素。

Objective To investigate the risk factors influencing the outcomes of patients with acute respiratory distress syndrome（ARDS）.Methods The clinical data of 145 patients from January 2008 to January 2011 were retrospectively analyzed.The patients were divided into the survivor group（n=80） and the non-survivor group（n=65）.The age,acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） score,sequential organ failure assessment（SOFA） score,the number of dysfunctional organs,sepsis severity,ARDS originating from pulmonary disease（ARDSp） and extra-pulmonary disease（ARDSexp） were analyzed to evaluate the prognosis.Results Univariate analysis showed that the age（P0.001）,APACHEⅡ score（P0.001）,SOFA score（P=0.003）,number of dysfunctional organs（P0.001）,sepsis severity（P0.001）,ARDSp and ARDSexp（P=0.043）,and anticoagulant application（P=0.006） had significant differences between the survivor group and the non-survivor group.Logistic regression analysis showed that APACHEⅡ（P=0.016,OR： 1.095,95% CI： 1.017-1.179）,sepsis severity（P0.001,OR： 2.559,95%CI： 1.609-4.072）,and ARDSp and ARDSexp（P=0.033,OR： 0.348,95% CI： 0.131-0.920） were the independent predictors of the mortality in patients with ARDS.Conclusion The APACHEⅡ scores,sepsis severity,and ARDS origin are the independent predictors of mortality in patients with ARDS.