74例老年急性呼吸窘迫综合征肺内和肺外源性因素分析

Pulmonary and extra-pulmonary factors for acute respiratory distress syndrome: Analysis of 74 elderly patients

目的比较老年患者中肺部原因诱发的急性呼吸窘迫综合征(acute respiratory distress syndrome of pulmonary origin,ARDSp)和肺外原因诱发的ARDS(ARDS of extra-pulmonary origin,ARDSexp)临床特征差异性。方法回顾性研究本院2000年1月-2012年6月收治的符合2012年ARDS柏林定义且年龄>60岁的老年患者临床资料。结果 ARDSp患者以肺炎最多见,占肺部原因的77.6%;ARDSexp最多见的是脓毒症,占43.8%。ARDSp与ARDSexp组入选时APACHEⅡ评分分别为20.4分和20.7分(P=0.898),肺损伤评分分别为2.7分和2.5分(P=0.385),序贯性器官功能衰竭(sequential organ failureassessment,SOFA)评分分别为6.1分和8.4分(P=0.013),住院病死率分别为58.6%及43.8%(P=0.289)。两组主要死亡原因均为多器官功能障碍综合征和严重呼吸衰竭。结论老年ARDS患者中,尽管ARDSexp组器官功能衰竭重于ARDSp组,但两组在APACHEⅡ评分、肺损伤评分、住院病死率以及主要死亡原因等方面无显著差异。

Objective To compare the clinical characteristics of elderly patients with pulmonary and extra-pulmonary acute respiratory distress syndrome（ARDS）.Methods Clinical data about 74 ARDS patients with their age60 years admitted to our hospital from January 2000 to June 2012 were retrospectively analyzed.Results Pneumonia was most common in elderly pulmonary ARDS patients（77.6%） and sepsis was most common in elderly extra-pulmonary ARDS patients（43.8%）.The APACHEⅡscore was 20.4 and 2.7,the lung injury score was 20.7 and 2.5,the sequential organ failure assessment（SOFA） score was 6.1 and 8.4,and in-hospital mortality was 58.6% and 43.8%,respectively,in elderly pulmonary ARDS patients and extra-pulmonary ARDS patients,respectively（P=0.898,P=0.385,P=0.013,P=0.289）.Multiple organ dysfunction syndrome and severe respiratory failure were the major causes of death in both pulmonary and extra-pulmonary patients.Conclusion The organ failure is severer in elderly extra-pulmonary ARDS patients than in elderly pulmonary ARDS patients,but no significant difference is found in their APACHEⅡand lung injury scores,in-hospital mortality,and major causes of death.