本文選題：急性呼吸窘迫綜合征 + 回顧性分析　； 參考：《第三軍醫(yī)大學(xué)》2013年碩士論文

【摘要】：研究背景和目的 急性呼吸窘迫綜合征(ARDS)是指排除心源性因素后，由各種肺內(nèi)外原因(嚴重的感染、休克及創(chuàng)傷等疾病)引起彌漫性肺實質(zhì)內(nèi)肺泡上皮細胞、肺毛細血管內(nèi)皮細胞的損傷，以肺容積及肺順應(yīng)性減低， V/Q比例嚴重失衡為病理生理學(xué)特點，臨床上表現(xiàn)為急性、進行性缺氧性呼吸衰竭及呼吸窘迫。ARDS為目前常見的危重病，涉及多個學(xué)科領(lǐng)域。估計全世界每十萬人口就有15-75例確診ARDS患者，每年全球有數(shù)以萬計的病例發(fā)生，，并且長期保持著較高發(fā)病率和居高不下的死亡率。本研究對我院ICU的重癥ARDS患者的臨床資料進行回顧性分析，目的是探討重癥ARDS患者的發(fā)病誘因、病死率及影響預(yù)后相關(guān)因素。 方法 收集我院呼吸科ICU2009年1月-2012年1月期間所有符合1999年9月中華醫(yī)學(xué)會呼吸病學(xué)分會在昆明召開的全國呼吸衰竭會議推薦的診斷標準，在此標準基礎(chǔ)上將PaO2/FiO2150mmHg作為重癥ARDS的納入標準。收集臨床資料包括：一般情況如患者性別、年齡、誘因、慢性病史，ARDS確診24h內(nèi)患者的生命體征、血氣分析、氧合指數(shù)、血常規(guī)、腎功能、電解質(zhì)、降鈣素原、CRP、血沉、乳酸、急性生理學(xué)和慢性健康狀況評分系統(tǒng)Ⅱ(APACHEⅡ評分)、ARDS確診后的治療方法、ICU滯留時間、機械通氣時間、多器官功能障礙的發(fā)生率以及確診后21天的病死率。目的是了解重癥ARDS患者各項臨床指標在生存組和死亡組之間是否存在統(tǒng)計學(xué)差異以及與患者病情的相關(guān)關(guān)系，探尋能預(yù)測重癥ARDS患者預(yù)后的指標。 結(jié)果 1.入選重癥ARDS病例共計34例，其中男性28例,女性6例,年齡在18～98歲之間,平均年齡(54.09±18.34)歲。直接肺損傷29例(85.3%),間接肺損傷5例(14.7%)。共死亡患者24例(70.6%)。23例患者合并MODS。 2.重癥ARDS患者中死亡組APACHEⅡ評分、血清乳酸及降鈣素原水平顯著高于存活組[分別為(23.42±4.59)vs(16.70±1.57),(4.83±3.60)vs(2.88±0.85)mmol/L,(3.02±2.87)vs(1.20±0.73)ng/L; P＜0.05],而氧合指數(shù)明顯低于存活組[(80.92±29.29)vs(112.30±24.49)mmHg; P＜0.05]。 3.重癥ARDS患者APACHEⅡ評分與血清乳酸及降鈣素原水平正相關(guān)(r=0.531,r=0.527; P＜0.01)。 4.重癥ARDS患者中出現(xiàn)1個器官衰竭的11例,存活5例(45.5%)，而出現(xiàn)2個器官功能衰竭的病例11例,存活4例(36.4%),器官功能衰竭≥3個的患者有12例,僅存活1例(8.3%)。 結(jié)論 血清乳酸及降鈣素原濃度在重癥ARDS患者存活組與死亡組間存在統(tǒng)計學(xué)差異，并且與重癥ARDS患者病情嚴重程度正相關(guān)。血清乳酸、降鈣素原聯(lián)合APACHEⅡ評分可能有助于判斷重癥ARDS患者的預(yù)后。重癥ARDS患者以原發(fā)病為主的對癥治療以及早期對多器官功能的保護的綜合治療能提高患者的生存率。
[Abstract]:Background and objective Acute Respiratory distress Syndrome (ARDS) refers to diffuse alveolar epithelial cells in the parenchyma of the lung caused by various causes (severe infection, shock, trauma, etc.) after cardiogenic factors are excluded. The injury of pulmonary capillary endothelial cells was characterized by decreased lung volume and lung compliance, serious imbalance of V / Q ratio, acute, progressive hypoxic respiratory failure and respiratory distress. It covers a wide range of disciplines. It is estimated that there are 15-75 diagnosed ARDS cases per 100,000 people in the world. Every year, tens of thousands of cases occur in the world, and the high incidence and high mortality rate are maintained for a long time. The aim of this study was to investigate the risk factors, mortality and prognostic factors of severe ARDS patients in ICU. Methods from January 2009 to January 2012, all the diagnostic criteria which were recommended by the National Respiratory failure Conference held by the Chinese Medical Association Respiratory Society in Kunming from January 2009 to January 2012 were collected. Pao _ 2 / Fio _ 2150 mmHg was added to the standard for severe ARDS. Clinical data were collected including: general conditions such as gender, age, inducement, vital signs, blood gas analysis, oxygenation index, blood routine examination, renal function, electrolyte, calcitonin proto CRP, erythrocyte sedimentation rate, lactic acid, chronic history of ARDS within 24 hours. Acute Physiology and chronic Health status scoring system 鈪

本文編號：2013810