细菌感染在急性肺损伤/急性呼吸窘迫综合征中的作用

Roles of bacterial infection in acute lung injury and acute respiratory distress syndrome

目的 探讨细菌感染在急性肺损伤 (ALI)和急性呼吸窘迫综合征 (ARDS)发病及进展中的作用。方法 分析10年间发生ALI、ARDS的 60 4例住院患者的临床资料。结果 ①导致直接肺损伤的首要原因为肺部感染 ,导致间接肺损伤的首要原因为全身性感染 ;②在所分离的致病菌中 ,革兰阳性球菌 ( 5 0 .76%)和革兰阴性杆菌 ( 4 0 .15 %)基本相等 ,金黄色葡萄球菌和铜绿假单胞菌分别为第一和第二位致病菌 ;③随SIRS分级的提高 ,感染患者ALI和ARDS的发病率均显著增加 (P <0 .0 5 ) ;④随发生功能障碍器官数的增多 ,感染患者ALI的发病率显著增加 (P <0 .0 5 ) ,当发生 2个以上器官 (即 1个肺外器官 )功能障碍时 ,感染患者ARDS病死率显著增加 (P <0 .0 5 ) ;⑤在治疗原发病、氧疗及抗感染基础上的综合治疗可显著提高患者的治愈率 (P <0 .0 5 )。结论 感染是ALI和ARDS发病的主要诱因 ;机会致病菌是导致感染的主要细菌 ;

Objective To explore the roles of bacterial infection in the pathogenesis and progression of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Methods The clinical data of 604 patients with ALI or ARDS hospitalized from April 1991 to March 2001 were analyzed. Results (1) The cause of direct lung injury was predominantly ascribed to lung infection, whereas indirect lung injury was due to sepsis. (2) The gram positive cocci (50.76%) and gram negative bacilli (40.15%) in the isolated pathogenic bacteria from patients were approximately similar. Furthermore, Staphylococcus aureus and Pseudomonas aeruginosa were the first and second pathogenic bacteria, respectively. (3) The incidences of ALI and ARDS in infected patients significantly increased with the grade elevation of systemic inflammatory response syndrome (SIRS) ( P <0.01). (4) The incidence of ALI was significantly elevated with the increased number of organs with dysfunction ( P <0.05). The fatality of ARDS patients significantly increased when more than 2 organ failures (including 1 other organ failure) occurred ( P <0.05). (5) Comprehensive therapies, including strategies such as therapy in primary diseases, antibiotic therapy with enough doses, oxygen therapy, and treatment of ARDS and ALI could improve the cure rate ( P <0.05). Conclusion Infection, predominantly caused by opportunistic pathogens such as Staphylococcus aureus and Pseudomonas aeruginosa , is the most important inducing factor of ALI and ARDS. Comprehensive therapies could improve the prognosis of ALI and ARDS patients.