北京地区急性呼吸窘迫综合征患者死亡相关因素分析

Analysis of Death-related Factors of Acute Respiratory Distress Syndrome in Beijing Area

目的分析影响ICU内急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者预后的危险因素。方法采用多中心回顾性研究方法,回顾收集自2009年7月到2014年3月入住北京大学第三医院、北京友谊医院、北京中日友谊医院、北京西苑医院及北京世纪坛医院ICU的ARDS患者相关信息。收集数据包括:一般情况、既往史、原发病及入ICU 24h内理化指标。根据出院时患者存活与死亡分为两组。对两组相关数据进行比较,并且对单因素分析有统计学差异的因素进行进一步Logistic回归分析,总结出影响ARDS预后危险因素。结果单因素分析显示:ARDS死亡组APACHEⅡ评分显著高于存活组[(20.55±6.28)vs.(17.20±7.00),P<0.01];男性病死率(59.7%)显著高于女性病死率(40.3%)(P<0.05);ARDS死亡组年龄显著大于存活组[(73.69±16.71)岁vs.(67.91±18.30)岁,P<0.05],但体重指数显著低于存活组[(23.66±3.28)vs.(25.04±3.49),P<0.05];原发病方面,死亡组肺炎及脓毒症休克发病率显著高于存活组(P<0.01);生化指标比较,死亡组胆红素水平(1.96±2.03)mg/dL显著高于存活组(1.22±0.93)mg/dL(P<0.01)。其他各指标比较两组差异均无统计学意义。Logistic回归分析显示:性别、脓毒症休克、肺炎、胆红素水平及年龄同ARDS死亡相关(均P<0.05)。结论脓毒症休克、肺炎、高胆红素水平、男性及高龄是ARDS死亡相关危险因素。

Objective To analyze the risk factors of the prognosis of patients with acute respiratory distress syndrome（ARDS）in intensive care unit（ICU）.Methods The multicenter retrospective research method was used in the study.Clinical data of ARDS patients who were treated in the ICU of Peking University Third Hospital,Beijing Friendship Hospital,Beijing Xiyuan Hospital,China-Japan Friendship Hospital and Beijing Shijitan Hospital between July 2009 and March 2014 were retrospectively analyzed.The data included the general condition,past medical history,primary disease and physical and chemical parameters within 24 hafter admission to ICU.The patients were divided into two groups according to the prognosis（survival or death）at the time of discharge.The indexes mentioned above were compared between the two groups.The risk factors for the prognosis of ARDS were analyzed by the univariate Logistic regression analysis.Results The univariate Logistic analysis showed that the APACHE Ⅱ score was significantly higher in death group than in survival group（20.55±6.28 vs.17.20±7.00,P〈0.01）.The mortality of male patients（59.7%）was significantly higher than that of the female patients（40.3%）（P〈0.05）.The patients were significantly older in death group than in survival group（73.69±16.71 years vs.67.91±18.30 years,P〈0.05）,and the body mass index（BMI）was significantly lower in death group than in survival group（23.66±3.28 vs.25.04±3.49,P〈0.05）.As for the primary disease,the incidence of pneumonia and septic shock was higher in the death group than in the survival group（P〈0.05）.Patients in the death group had a higher level of bilirubin（1.96±2.03）mg/dL than those in the survival group（1.22±0.93）mg/dL（P〈0.05）.There were no statistical differences between the two groups in other indexes.Logistic regression analysis showed that the sex,septic shock,pneumonia,bilirubin level and age were associated with ARDS death.Conclusion The septic shock,bilirubin level,pneumonia,gender and age are the risk factors that affect the survival of ARDS patients.