ARDS严重程度在多脏器功能衰竭预后评估中的意义研究

the Significance of ARDS Severity in the Prognosis Assessment of Multiple Organ Failure

目的探讨与研究急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)严重程度在多脏器功能衰竭预后评估中的意义。方法回顾性选择2019年5月~2021年5月江苏省徐州市中医院重症医学科收治的110例多脏器功能衰竭患者作为研究对象,判定所有患者ARDS严重程度,调查患者的预后并进行相关性分析。结果所有患者随访到2022年2月,无流失病例,死亡20例,死亡率为18.18%。死亡组的年龄、机械通气时间明显高于生存组,差异有统计学意义(P<0.05)。死亡组的ARDS发生率明显高于生存组,急性生理学及慢性健康状况评分(acute physiology and chronic health evaluation,APACHEⅡ)和临床肺部感染评分(clinical pulmonary infection score,CPIS)评分明显高于生存组,差异有统计学意义(P<0.05)。Spearman和Pearson相关分析显示有ARDS、临床肺部感染评分、APACHEⅡ评分、年龄、机械通气时间与预后死亡存在明显相关性(P<0.05)。多因素logistic回归显示ARDS、临床肺部感染评分、APACHEⅡ评分、年龄、机械通气时间都为导致患者死亡的主要因素(P<0.05)。受试者操作特性曲线(receiver operator characteristic curve,ROC)分析显示ARDS评估多脏器功能衰竭预后死亡的曲线下面积(area under curve,AUC)值为0.918。结论多脏器功能衰竭多伴ARDS,可导致患者预后不良。ARDS、临床肺部感染评分、APACHEⅡ评分、年龄、机械通气时间都为导致患者死亡的主要因素,有ARDS对预测评估多脏器功能衰竭患者预后具有重要价值。

Objective To explore and study the significance of acute respiratory distress syndrome(ARDS)severity in the prognosis assessment of multiple organ failure.Methods From May 2019 to May 2021,110 patients with multiple organ failure were selected in the department of critical care medicine of Xuzhou hospital of traditional Chinese medicine,Emergency Intensive Care Unit(EICU)were selected as the research object,the severity of ARDS in all patients were determined,and the prognosis of the patients were investigated and given correlation analysis.Results All patients were followed up until February 2022,with no loss of cases and 20 deaths,and the mortality rate was 18.18%.The age and mechanical ventilation time of the death group were signifi cantly higher than those of the survival group,and the diff erence was statistically signifi cant(P<0.05).The incidence of ARDS in the death group were higher than that in the survival group,and the acute physiology and chronic health evaluation(APACHE II)and clinical pulmonary infection score(CPIS)scores were higher than those in the survival group that compared were statistical significance(P<0.05).Spearman and Pearson correlation analysis showed that the prognosis of deathwere correlated to the ARDS,APACHE II score,CPIS score,age,mechanical ventilation time(P<0.05).Multivariate logistic regression showed that ARDS,APACHE II score,CPIS score,age,and mechanical ventilation time were the main factors leaded to death(P<0.05).Receiver operator characteristic curve(ROC)analysis showed that ARDS evaluated the area under curve(AUC)value of multi-organ failure prognosis and death were 0.918.Conclusion Multiple organ failures are often accompanied by ARDS,which can lead to poor prognosis.ARDS,APACHE II score,CPIS score,age,and mechanical ventilation time are the main factors leading to the death of patients.