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目的 了解肺内、肺外诱因对急性呼吸窘迫综合征 (ARDS)预后的影响。方法 收集我院重症监护病房 2 0 0 0年 5月～ 2 0 0 1年 12月收治的 4 4例ARDS患者临床资料 ,比较肺内、外诱因所致ARDS患者各项临床特征及预后的差异。结果 本组 4 4例患者中 ,肺内组 15例 ,男 4例 ,女 11例 ,平均年龄为 (5 9.0± 18.5 )岁 ;肺外组 2 9例 ,男 14例 ,女 15例 ,平均年龄为 (5 2 .7± 2 1.9)岁 ;两组患者年龄、性别、基础疾病、营养状况、氧合指数 (氧分压 /氧浓度 )、肺内分流值、急性生理功能与慢性健康状况评分Ⅱ、呼气末正压水平、接受机械通气治疗时间、合并感染性休克和 (或 )多脏器功能不全 (MODS)等的差异无显著性 (P >0 .0 5 ) ;肺外组机械通气治疗后氧合状况改善较肺内组明显 (P <0 .0 5 ) ;肺内、外组感染病原菌不明确或混合感染发生率的差异无显著性 (P >0 .0 5 ) ,肺内组的抗菌疗效低于肺外组 (P <0 .0 5 ) ;肺内组病死率 (93.3% )高于肺外组 (4 4 .8% ,P <0 .0 1)。结论 肺内因素所致ARDS患者病死率明显高于肺外组 ,主要原因为肺部感染控制不佳
Objective To investigate the effect of extrapulmonary and extrapulmonary incentives on the prognosis of acute respiratory distress syndrome (ARDS). Methods The clinical data of 44 ARDS patients admitted to ICU in our hospital from May 2000 to December 2001 were collected to compare the clinical characteristics and prognosis of patients with ARDS induced by intrapulmonary and external causes . Results Among the 44 patients in our study, there were 15 patients in the lung group, 4 males and 11 females, with an average age of (5 9.0 ± 18.5) years. There were 29 males and 14 females and 15 females with an average of (52.7 ± 2.1.9 years). The age, gender, underlying diseases, nutritional status, oxygenation index (oxygen partial pressure / oxygen concentration), pulmonary shunt, acute physiology and chronic health status There was no significant difference between the two groups (P> 0.05), the score Ⅱ, the positive end-expiratory pressure, the duration of mechanical ventilation, complicated septic shock and / or multiple organ dysfunction (MODS) The improvement of oxygenation after mechanical ventilation was better than that of the pulmonary group (P <0.05). There was no significant difference in the incidence of unclear or mixed infection of pathogenic bacteria in the lung and external groups (P> 0.05) The antimicrobial efficacy in the lung group was lower than that in the extrapulmonary group (P <0.05). The mortality in the lung group (93.3%) was higher than that in the extrapulmonary group (44.8%, P <0.01). Conclusion The mortality of ARDS caused by intra-pulmonary factors is significantly higher than that of the extra-pulmonary group, mainly due to the poor control of pulmonary infection