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目的 :探讨急性呼吸窘迫综合征 (ARDS)病死率居高不下因素。方法 :收集 1年 8个月中因ARDS收入ICU所有患者的临床资料 (原发病或诱发因素、APACHEⅡ评分、严重程度、机械通气治疗和PEEP水平、糖皮质激素 ) ,分析各种特定危险因素与病死率之间关系 ,χ2 检验差异显著性。结果 :4 4例中 ,年龄 5～ 84岁 (5 4 .5± 2 1.5 )岁 ;肺内组病死率 93.3% (14 /15例 ) ,肺外组 4 4 .8% (13/2 9例 ) ,肺内组高于肺外组 (P <0 .0 1) ;APACHEⅡ评分≤ 2 0分组病死率低于≥ 31分组 (P <0 .0 5 ) ;以PaO2 /FiO2 和 Qs/ QT判断严重程度 ,对预后无显著影响 (P >0 .0 5 ) ;PEEP水平 6～ 10cmH2 O组病死率低于≥ 11cmH2 O组 (P <0 .0 5 ) ;机械通气治疗组病死率明显低于未接受机械通气治疗组 ,P <0 .0 5 ;34例接受不同类型激素治疗病死率 (70 .6 % )高于未接受激素治疗组 (30 .0 % ) ,差异显著 (P <0 .0 1) ,应用时间与剂量间无显著差异 (P >0 .0 5 ) ;直接死亡原因为ARDS未得到纠正者仅占 11.1% (3/2 7例 ) ,明显低于感染性休克和MODS(P <0 .0 1)。结论 :在及时应用机械通气治疗前提下 ,肺内疾病和APACHEⅡ评分≥ 31可能是预报ARDS病死率高的指标。
Objective: To investigate the high mortality rate of acute respiratory distress syndrome (ARDS). METHODS: The clinical data (primary disease or predisposition, APACHE II score, severity, mechanical ventilation and PEEP levels, glucocorticoids) from all patients with ARDS in the ICU at 1 year and 8 months were collected and analyzed for specific risk factors And the relationship between mortality, χ2 test significant difference. Results: Among 44 cases, the age ranged from 5 to 84 years old (54.5 ± 2.1.5 years). The mortality rate in the lung group was 93.3% (14/15 cases), that in the extrapulmonary group was 44.8% (13/2 9) (P <0.01). The mortality of APACHEⅡ≤20 was lower than that of ≥31 (P <0.05). PaO2 / FiO2 and Qs / QT The severity of death had no significant effect on the prognosis (P> 0.05); the mortality of PEEP group 6 ~ 10cmH2O was lower than that of> 11cmH2O (P <0.05); the death rate of mechanical ventilation group was significantly lower In the group without mechanical ventilation, P <0.05; 34 cases received different types of hormone treatment mortality (70.6%) than those without hormone therapy group (30.0%), the difference was significant (P <0 .0 1). There was no significant difference between application time and dose (P> 0.05). The direct cause of death was only 11.1% (3/27) of unrelated ARDS patients, which was significantly lower than that of septic shock and MODS (P <0 .01). Conclusion: Under the prompt application of mechanical ventilation, pulmonary disease and APACHE Ⅱ score ≥ 31 may be predictors of high ARDS mortality.