血浆脂联素水平与胸心外科ICU中急性呼吸窘迫综合征患者预后关系的临床研究

Relationship between adiponectin level and prognosis of acute respiratory distress syndrome in a cardiothoracic surgery ICU： a single center prospective cohort study

目的对胸心外科ICU术后急性呼吸窘迫综合征（ARDS）发病情况进行分析，探讨血浆脂联素（adiponectin，APN）水平和ARDS临床参数、病情轻重及预后等多种因素相关性。方法本研究是前瞻性队列研究。选取重庆医科大学附属第一医院胸心外科ICU收治的16周岁以上至少包含了一个ARDS危险因素的患者，并排除深静脉血栓及肺栓塞。研究时间12个月。分析患者的临床参数和ARDS柏林分型。研究血浆APN水平与患者临床参数、病情轻重及预后的关系。结果ARDS发病率为17．9％，ARDS死亡率为25．8％。APN〉5mg／L组平均APACHEⅡ评分（12．2分）、PEEP（15．1cmH20）与APN〈5mg／L组（16．3分和8．3cmH20）比较差异有统计学意义，而pH更高。重度ARDS组患者APN水平（2．91±1．33）mg／L显著低于轻度ARDS患者（7．28±1．54）mg／L，差异有统计学意义（P〈0．05）。死亡和脱机困难患者APN水平（1．99±1．03）mg／L显著低于存活及成功脱机患者（10．14±2．02）mg／L，差异有统计学意义（P〈0．05）。结论在心肺术后及严重胸部创伤后，ARDS发病率高、病情重、死亡率高。死亡和脱机困难患者APN水平显著低于存活及成功脱机患者，提示血浆APN水平与患者预后存在关联，低APN水平可能提示患者预后差，死亡几率增大。

Objective To analyze the prevalence of acute respiratory distress syndrome （ARDS） in a single cardiothoracic surgery ICU and discuss the relationship between adiponectin （APN） level and ARDS clinical parameters, pathogenic condition and clinical outcome. Methods This is a prospective cohort study. Patients over 16 years old in cardiothoracic surgery ICU were studied. The time period was 12 months. ARDS type and clinical parameters were analyzed. The relationship between APN level and clinical parameters, severity of clinical manifestation and clinical outcomes were also studied. Results The morbidity of ARDS was 17.9%. The mortality was 25.8%. APACHE Ⅱ score, PEEP were lower in the APN 〉 5 mg/L group, while the APN 〈 5 mg,/L group were higher in pH. APN level in patients with less severe clinical manifestations was higher than that of severe group （ P 〈 0. 05 ）. Conclusion ARDS is a common complication in the cardiothoracic surgery ICU. APN level is related to the severity of disease and clinical outcome. Lower level of APN may suggest a bad outcome and a high risk of ARDS death.