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目的探讨急诊肺炎患者发生急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的早期危险因素。方法回顾性分析中国医科大学附属第一医院急诊科收治的100例肺炎患者,其中男性62例,女性38例;年龄49~79岁,平均年龄62岁。观察72h,发展至ALI/ARDS为ALI/ARDS组,未发展至ALI/ARDS的分为单纯肺炎组。收集两组患者的年龄、性别、生命体征、初始所需吸氧浓度及初诊的实验室检查(白细胞、血小板计数、血清白蛋白、尿素氮、丙氨酸氨基转移酶)指标,对各项因素进行单因素分析,单因素分析有显著意义的变量行二项分类的Logistic回归分析。结果 100例患者35例发展为ALI/ARDS,65例未发展为ALI/ARDS。单因素分析结果显示,患者是否发展为ALI/ARDS与年龄、性别、体温、呼吸频率、休克、白细胞计数、尿素氮等比较,差异无统计学意义(P>0.05);初始所需吸氧浓度(维持血氧饱和度≥90%)、改良后的快速急诊内科评分(REMS)、低蛋白血症与发展为ALI/ARDS差异有统计学意义(P<0.05)。二项分类的Logistic回归分析显示,仅吸氧浓度、改良后的REMS评分是发展为ALI/ARDS的独立危险因素。其中吸氧浓度>2 L/min的灵敏度为77.1%,特异度为86.2%;改良后的REMS≥7发生ALI/ARDS灵敏度为74.3%,特异度为72.3%。结论初始吸氧浓度及改良后的REMS评分与ALI/ARDS的发生存在正相关,初始吸氧浓度>2 L/min和/或改良后的REMS≥7的肺炎患者应予以重视,是ALI/ARDS的高危患者,争取做到早期诊治。
Objective To investigate the early risk factors of acute lung injury (ALI) / acute respiratory distress syndrome (ARDS) in emergency pneumonia patients. Methods A retrospective analysis of 100 cases of pneumonia admitted to the Emergency Department of the First Affiliated Hospital of China Medical University included 62 males and 38 females, with a mean age of 62 years ranging from 49 to 79 years. Observation 72h, the development of ALI / ARDS ALI / ARDS group, did not develop to ALI / ARDS divided into simple pneumonia group. The age, gender, vital signs, initial required oxygen concentration and newly diagnosed laboratory tests (white blood cell, platelet count, serum albumin, urea nitrogen and alanine aminotransferase) were collected. The factors Univariate analysis, univariate analysis of significant variables in the binary classification of Logistic regression analysis. Results 35 cases of 100 patients developed ALI / ARDS, 65 cases did not develop ALI / ARDS. Univariate analysis showed that there was no significant difference between ALI / ARDS and age, sex, body temperature, respiratory rate, shock, white blood cell count, urea nitrogen and other indexes in patients with ALI / ARDS (P> 0.05) (Maintain the blood oxygen saturation≥90%). There was a significant difference between the improved rapid emergency medical score (REMS), hypoproteinemia and development of ALI / ARDS (P <0.05). Logistic regression analysis of the binomial categories showed that only oxygen concentration and the improved REMS score were independent risk factors for the development of ALI / ARDS. The sensitivities of oxygen concentration> 2 L / min were 77.1% and specificity was 86.2%. The modified ALS / ARDS had a sensitivity of 74.3% and a specificity of 72.3%. Conclusions The initial oxygen inhalation concentration and the improved REMS score have a positive correlation with the occurrence of ALI / ARDS. Patients with pneumonia with initial oxygen concentration> 2 L / min and / or modified REMS ≥ 7 should be paid attention to, Of high-risk patients, strive for early diagnosis and treatment.