腹膜炎患者术后急性呼吸窘迫综合征的临床特点及危险因素分析

Features and risk factors analysis of early postoperative acute respiratory distress syndrome in patients with acute peritonitis

目的探讨急性腹膜炎患者手术后早期急性呼吸窘迫综合征(ARDS)的临床特点及危险因素。方法回顾性分析南京大学医学院附属鼓楼医院重症医学科(ICU)2016年7月1日至2018年12月31日行急诊手术的急性腹膜炎162例患者临床资料,根据患者术后72 h内是否发生ARDS分为ARDS组和非ARDS组,收集患者基本信息、基础生理指标、实验室检查、术中及术后因素等,进行单因素分析和Logistic回归分析以探求腹膜炎患者术后ARDS发生的危险因素。结果162例急性腹膜炎患者手术后早期ARDS发病率24.07%(39例)。与非ARDS组相比,ARDS组患者APACHEⅡ评分、SOFA评分、血白细胞、乳酸、术中液体平衡、出血量、输血及休克、去甲肾上腺素剂量>0.1μg/(kg·min)差异均有统计学意义(P<0.05)。Logstic多因素回归分析提示:SOFA评分(OR=1.730,95%CI=1.356~2.205,P=0.000)、术中液体平衡(OR=1.002,95%CI=1.000~1.003,P=0.028)、输血(OR=0.119,95%CI=0.017~0.830,P=0.032)、休克(OR=0.224,95%CI=0.054~0.919,P=0.038)及去甲肾上腺素剂量>0.1μg/(kg·min)(OR=9.044,95%CI=1.158~70.632,P=0.036)为影响急性腹膜炎患者手术后发生ARDS的危险因素。ARDS组患者ICU住院时间[(6.12±5.51)d]、机械通气时间[(58.59±65.82)h]及30 d病死率(15.38%)明显高于非ARDS组[(3.20±2.75)d、(13.75±14.91)h、4.07%,P<0.05],2组肺炎发生率比较差异无统计学意义(P>0.05)。结论ARDS是急性腹膜炎手术后常见的并发症,其中SOFA评分、术中液体平衡、输血、休克及去甲肾上腺素剂量>0.1μg/(kg·min)是急性腹膜炎患者早期发生ARDS的危险因素。

Objective To discuss the features and risk factors of postoperative acute respiratory distress in the patients with acute abdomen surgery.Methods A total of 162 patients admitted to intensive care unit(ICU)from July 2016 to December 2018 were included in the study.The patients were assigned into the acute respiratory distress syndrome(ARDS)group and non-ARDS group.The basic information,physiological indicators and laboratory examinations,intraoperative and postoperative factors were collected for univariate analysis and logistic regression to explore the risk factors for ARDS in patients with peritonitis.Results The overall incidence of ARDS was 24.07%(39 cases).Univariate analysis revealed that there were significant differences in APACHEⅡscore,SOFA score,leukocyte count,blood lactate concentration,total fluid balance,blood products,shock,infusion of norepinephrine>0.1μg/(kg·min)(P<0.05).The variables were found to be significantly related to ARDS by Logistic regression:SOFA score(OR=1.730;95%CI=1.356-2.205;P=0.000),total fluid balance(OR=1.002;95%CI=1.000-1.003;P=0.028),blood products(OR=1.002;95%CI=1.000-1.003;P=0.028),shock(OR=0.224;95%CI=0.054-0.919;P=0.038),infusion of norepinephrine>0.1μg/(kg·min)(OR=9.044;95%CI=1.158-70.632;P=0.036).The ICU duration time[(6.12±5.51)d],mechanical ventilation time[(58.59±65.82)h]and 30-d mortality rate(15.38%)of the ARDS group were statistically higher than those in non-ARDS group[(3.20±2.75)d,(13.75±14.91)h,4.07%,all P<0.05)].There was no significant difference in the incidence of pneumonia between the two groups(P>0.05).Conclusion ARDS is a common complication after surgery with acute peritonitis.This study shows that SOFA score,total fluid balance,blood products,shock,infusion of norepinephrine>0.1.