急性呼吸窘迫症合并慢性阻塞性肺疾病患者预后影响因素研究

Prognostic factors of patients with acute respiratory distress combined with chronic obstructive pulmonary disease

目的探讨急性呼吸窘迫症(ARDS)合并慢性阻塞性肺疾病(COPD)患者预后的影响因素。方法76例ARDS合并COPD患者,男43例,女33例,年龄(51.62±8.12)(35~80)岁,均接受常规治疗,并经口面罩性无创正压机械通气。收集相关的人口学和临床数据。采集患者桡动脉血,测定氧分压(PaO_(2))及吸入氧浓度(FiO_(2)),并计算氧合指数(PaO_(2)/FiO_(2))。抽取患者肘静脉血,采用肌氨酸氧化酶法检测血清肌酐水平。随访4周后分为两组,即死亡组(n=22)与存活组(n=54)。采用多因素Logistic回归分析影响ARDS合并COPD患者预后的因素。结果随访4周,76例患者中22例死亡,病死率为28.95%,54例存活。两组患者性别、体质量指数、吸烟、饮酒、肌酐水平相比,差异无统计学意义(均P>0.05),死亡组年龄、急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、BODE指数、既往肺炎病史比例和合并多器官功能衰竭综合征(MODS)比例均明显高于存活组(均P<0.05),死亡组住院时间和机械通气时间均明显长于存活组(均P<0.05)。Logistic回归分析结果显示,年龄、APACHEⅡ评分、BODE指数及合并MODS是ARDS合并COPD患者预后不良的独立危险因素。结论年龄较大、合并MODS及APACHEⅡ评分、BODE指数评分较高的ARDS合并COPD患者预后不良发生风险较高。

Objective To investigate the influencing factors of prognosis of patients with acute respiratory distress syndrome(ARDS)complicated with chronic obstructive pulmonary disease(COPD).Methods 76 ARDS patients complicated with COPD,43 males and 33 females,aged(51.62±8.12)(35~80),underwent routine treatment,including transoral mask noninvasive positive pressure ventilation.Related demographical and clinical data were collected.Arterial blood samples were collected from radial artery to measure the alveolar oxygen partial pressure(PaO_(2))and fraction of inspired oxygen(FiO_(2))so as to calculate the oxygenation index(PaO_(2)/FiO_(2)).Peripheral venous blood samples were collected from ulnar vein to detect the serum creatinine level by sarcosine oxidase method.These patients were followed up for 4 weeks and then were divided into 2 groups:death group(n=22)and survival group(n=54).Multivariate Logistic regression analysis was used to analyze the factors affecting the prognosis of ARDS complicated with COPD.Results The follow-up of 4 weeks showed that 22 of the 76 patients died with a mortality of 28.95%,and 54 survived.There were no significant differences in gender,body mass index,smoking history,drinking history,and creatinine level between these two groups(all P>0.05).The age,APACHE Ⅱ score,BODE index,proportions of previous pneumonia history,and proportions of complicated MODS of the death group were all significantly higher than those of the survival group(all P<0.05),and the hospital stay and duration of mechanical ventilation of the death group were both significantly longer than those of the survival group(both P<0.05).Logistic regression analysis showed that age,APACHE Ⅱ score,BODE index,and combined MODS were independent risk factors for poor prognosis in the ARDS patients complicated with COPD.Conclusion Older age,combined MODS,higher APACHE Ⅱ score and BODE index score are higher risk factors of poor prognosis in ARDS patients with COPD.