189例急性呼吸窘迫综合征患者的病死危险因素分层分析

Stratified analysis of predictors of in-hospital mortality in 189 patients with ARDS

目的研究不同严重程度急性呼吸窘迫综合征（acuterespiratorydistresssyndrome，ARDs）患者的病死危险因素。方法回顾性研究解放军总医院2000年1月至2012年6月收治的符合2012年ARDS柏林定义的患者的临床资料，根据氧和指数将其分为轻、中度组及重度组，分别采用单因素及多因素Logistic回归分析各种因素与病死率之间的关系。结果纳入189例患者，年龄18～89岁，平均（52．9±18．2）岁，轻、中、重度患者分别24例、102例及63例，病死率分别为20．8％、45．1％及63．5％。多因素Logistic回归分析显示预测轻一中度ARDS患者病死的危险因素包括：确诊前住院时间〉48h及急性生理学和慢性健康评价（APACHEⅡ）评分；预测重度患者病死的危险因素包括：序贯性器官功能衰竭评分及确诊时处于免疫抑制状态。结论不同严重程度ARDS患者的预后危险因素不同，因此对于轻一中度ARDS患者，应更加重视早期诊断及开始相应的治疗；而对于重度患者，应注重及早发现及保护出现功能障碍的器官和免疫调理治疗。

Objective To determine the predictors of in-hospital mortality in patients with acute respiratory distress syndrome （The Berlin Definition）. Methods The clinical data 0f 189 patients with acute respiratory distress syndrome （ARDS） from January 2000 to June 2012 were collec＇ted and analyzed. All patients were divided into mild-moderate group and severe group accord to PaO2/FiO2. Univariate and multivariate logistic regression analyses were performed to assess the association between the risk factors and the mortality. Results Of the 189 cases analyzed, age ranged from 18 to 89 years： [mean age （52.9±18.2） years]. There are 24 patients with mild ARDS,102 patients with moderate ARDS,and 63 patients with severe ARDS, the in hospital mortality was 20.8%, 45.1%and 63.5%, respectively. Multivariate logistic regression analyses indicated that predictors of in-hospital mortality in patients with mild-moderate ARDS were APACHE Ⅱ and duration of hospital stay before ARDS onset ）48 h, and predictors of in-hospital mortality in patients with severe ARDS were mmunosuppression and Sequential Organ Failure Assessment scores. Conclusions Predictors of in-hospital mortality between ARDS patients with different severity may be different. For patients with mild-moderate ARDS, we should pay more attention to early diagnosis and began to the corresponding treatment. Whereas for patients with severe ARDS, early detection and protection of failure organs and immunomodulating therapy may be more important.