| 陈 伟,杨 揆,郑 龙,张天相,王晓苏,宋立强.合并慢性气道疾病的ARDS临床特征及预后影响因素研究[J].,2020,(5):866-870 |
| 合并慢性气道疾病的ARDS临床特征及预后影响因素研究 |
| Clinical Characteristics and Prognostic Factors of ARDS with Chronic Airway Disease |
| 投稿时间：2019-08-10 修订日期：2019-08-31 |
| DOI：10.13241/j.cnki.pmb.2020.05.014 |
| 中文关键词: 急性呼吸窘迫综合征 COPD 支气管哮喘 临床特征 预后 |
| 英文关键词: Acute respiratory distress syndrome COPD Bronchial asthma Clinical characteristics Prognosis |
| 基金项目:国家自然科学基金面上项目（81570072）；陕西省社会发展科技攻关项目（2016SF-096） |
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| 中文摘要: |
| 摘要 目的：探讨急性呼吸窘迫综合征（ARDS）合并慢性气道疾病患者的临床特征及影响预后的因素。方法：167例ARDS患者根据并发症发生情况分为对照组（单纯性ARDS组，A组，n=39）及观察组（ARDS合并慢性气道疾，B组，n=49，C组，n=41，D组，n=38），比较各组患者一般情况、临床特征、生化指标、治疗方式及预后状况，通过logistic回归分析ARDS合并慢性气道疾病患者预后的影响因素。结果：观察组（B、C、D组）年龄、中性粒细胞、IL-6、IL-8、TNF-α、白蛋白、pro-BNP、乳酸、氧合指数、住院时间、住院费用与对照组（A组）比较差异有统计学意义，P＜0.05；128例ARDS合并慢性气道疾病患者中死亡76例，好转52例，病死率59.38%；单因素分析结果显示，观察组（B、C、D组）患者中临床结局好转患者与死亡患者比较，白细胞、淋巴细胞、CRP、TNF-α、IL-8、降钙素、肌酐、pro-BNP、氧合指数、住院费用、机械通气时间、抗生素数量差异有统计学意义，P＜0.05；通过多因素logistic回归分析发现肌酐是影响ARDS合并慢性气道疾病的潜在危险因素，氧合指数为保护因素，P＜0.05。结论：ARDS合并慢性气道疾病的能量代谢紊乱程度可能较单纯ARDS加重，且两者炎性特征不同。肌酐、氧合指数是影响ARDS合并慢性气道疾病的重要影响因素。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the clinical characteristics and prognostic factors of patients with acute respiratory distress syndrome (ARDS) complicated with chronic airway disease. Methods: According to the occurrence of complications, 167 patients with ARDS were divided into two groups-control group (ARDS group, group A, n=39) and observation group (ARDS with chronic airway disease, group B, n=49, group C, n=41, group D, n=38). The general condition, clinical characteristics, biochemical indexes, treatment methods and prognosis of each group were compared, and the prognostic factors of ARDS patients with chronic airway diseases were analyzed by logistic regression. Results: There were significant differences in age, neutrophils, interleukin-6 (IL-6), IL-8, tumor necrosis factor-α(TNF-α)，albumin, pro-BNP, lactic acid, oxygenation, hospitalization time and hospitalization cost index between the observation group (group B, C, D) and the control group (group A) (P<0.05). Among the 128 patients with both ARDS and chronic airway disease, 76 patients died, 52 patients were improved, with mortality rate of 59.38%. Univariate analysis showed that there were significant differences in white blood cell, lymphocyte, C reactive protein (CRP), TNF-α, IL-8 calcitonin, creatinine, pro-BNP, oxygenation index, hospitalization cost, time on mechanical ventilation and number of antibiotics between the patients with improved clinical outcome and those who died in the observation group (groups B, C and D), P<0.05; multivariate logistic regression analysis revealed that creatinine was a potential risk factor affecting ARDS complicated with chronic airway disease, and oxygenation index was a protective factor, P<0.05. Conclusion: The disorder of energy metabolism in ARDS patients with chronic airway disease may be more severe than that of simple ARDS and shown different inflammatory characteristics. Creatinine and oxygenation index are the important influencing factors of ARDS with chronic airway diseases. |
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