脓毒症并发急性呼吸窘迫综合征的危险因素及预测评分研究进展

Research progress on risk factors and predictive scores of sepsis patients developing into acute respiratory distress syndrome

脓毒症是急性呼吸窘迫综合征(ARDS)最常见的危险因素,脓毒症并发ARDS患者预后较差,目前对ARDS的治疗策略仍为器官功能支持治疗。脓毒症的治疗需要早期识别急性肺损伤(ALI),并以预测和预防ARDS为重点。由于脓毒症相关ARDS的特殊性,需要进一步分析脓毒症并发ARDS的危险因素并建立预测评分模型。脓毒症患者发生ARDS的危险因素包括基础疾病、疾病严重程度、临床特点、治疗的影响及生物标志物等。早期急性肺损伤评分(EALI)、肺损伤预测评分(LIPS)及其衍生评分对评估脓毒症患者发生ARDS的风险有一定意义,但目前尚无针对脓毒症患者的预测评分研究。该文就脓毒症患者及肺部感染患者发生ARDS的危险因素、ALI/ARDS预测评分、LIPS衍生评分的研究进展进行综述,以期为后续研究提供参考。

Sepsis is the most common risk factor of acute respiratory distress syndrome(ARDS),sepsis related ARDS patients means worse prognosis,however,at present,the treatment strategy for ARDS is still organ function support.Early identification of acute lung injury is of great importance,and the focus of attention to such disease should be on early recognition and effective preventive measures.Because ARDS is a heterogeneous syndrome,sepsis related ARDS and non-sepsis related ARDS have different clinical characteristics and prognosis.It is necessary to further analyze the risk factors of ARDS in septic patients and establish predictive scores.At present,based on previous studies,the risk factors for ARDS include basic diseases,disease severity,clinical characteristics,therapeutic effects and biomarkers for septic patients.Early acute lung injury score(EALI),lung injury prediction score(LIPS)and its derivative score have certain implication for sepsis,but there was no available prediction score for sepsis patients specifically.In this article,we discuss the clinical significance and deficiency of relevant research from four aspects:risk factors of ARDS for sepsis patients,risk factors of ARDS in patients with pulmonary infection,acute lung injury/ARDS predictive score and LIPS derived score,and to provide suggestions for the subsequent studies.