胃肠穿孔伴脓毒性休克患者ARDS危险因素分析

Risk factor analysis of ARDS in patients with gastric-intestinal perforation complicated with septic shock

目的 探讨胃肠穿孔后脓毒性休克患者急性呼吸窘迫综合征（ARDS）的危险因素.方法 收集2005年7月~2012年10月在我科手术后进入中心ICU的99例胃肠穿孔伴脓毒性休克患者临床资料,回顾性分析发生ARDS的相关危险因素.结果发生ARDS 47例（69.16%）,死亡19例（19.19%）.单因素分析显示,年龄≥65岁、APACHE Ⅱ≥15、BMI≥30 kg/m^2、吸烟指数≥400支/年、穿孔时间≥8 h、休克且持续时间≥4 h、术中复苏液量≥3000 ml、入ICU时乳酸水平≥2.5 μmol/L、结肠穿孔、合并糖尿病和/或COPD以及首次血/痰细菌培养阳性等,是胃肠穿孔后ARDS的独立高危因素.结论 胃肠穿孔后早期监测和控制这些高危因素,可以降低ARDS发生率.

Objective To analyze the risk factors of acute respiratory distress syndrome （ARDS） in patients with gastric- intestinal perforation complicated with septic shock. Methods Retrospective analysis was made in the clinical data of 99 patients with gastric-intestinal perforation complicated with septic shock who received the operation and were sent to the ICU between July 2005 and October 2012. The risk factors causing the incidence of ARDS were analyzed. Results ARDS occurred in 47 cases （69.16%） in which 19 ones died （ 19.19% ）. The single factor analysis indicated that the independent and high risk factors of ARDS after gastric-intestinal perforation included age ≥ 65, APACHE Ⅱ ≥15, BMI ≥30 kg/m^2, smoking index ≥20 ×20 pieces/year, the time of perforation ≥ 8 hours, shock and time persistence ≥4 hours, resuscitation fluid ≥3000 ml during the operation,lactic acid level ≥2.5 μmol/L when admitted in ICU, colonic perforation,affiliated diabetes and/or COPD, and positive results of the first blood or sputum germicuhure, etc. Conclusion Early monitoring and controling those high risk factors after the gastric-intestinal perforation can decrease the incidence of ARDS.