食管癌术后吸入性肺炎合并急性呼吸窘迫综合征的预后高危因素分析

Analysis in high- risk factors for prognosis of patients with aspirationpneumonia combined with ARDS after esophagectomy

目的探讨食管癌术后吸入性肺炎肺炎并发急性呼吸窘迫综合征(ARDS)死亡的高危因素。方法回顾性分析64例食管癌术后吸入性肺炎并发ARDS患者的临床资料。按其预后分为存活组和死亡组,对死亡相关的因素进行单因素及多因素Logistic回归分析。结果本组病死率为39.1%。多因素Logistic回归分析发现,氧合指数<150 mm Hg、多脏器功能衰竭综合征、高龄(>70岁)、手术方式(三切口)是食管癌术后吸入性肺炎合并ARDS患者死亡的独立危险因素。结论早期集束化治疗、积极改善动脉氧分压、阻止MODS的发生是改善食管癌术后吸入性肺炎合并ARDS患者预后的重要措施。

Objective To explore the risk factors for prognosis of patients with pneumonia complicated with acute respiratory distress syndrome（ ARDS） after esophagectomy. Methods Clinical materials of 64 patients with aspiration pneumonia complicated with ARDS after esophagectomy were retrospectively analyzed. According to their prognosis,the patients were divided into survival group and death group,and the factors associated with death were analyzed by Logistic analysis. Results The mortality rate was 39. 1%. Multiple Logistic analysis showed that oxygen index less than150 mm Hg,advanced age（〉 70 years old）,surgical procedure（ three incisions） and MODS were the risk factors of death in patients with aspiration pneumonia complicated with ARDS after esophagectomy（ P〈0. 05）. Conclusion Early cluster therapy,improvement of p（ O2） and prevention of MODS are the important measures for patients with aspiration pneumonia complicated with ARDS after esophagectomy.