心脏术后急性呼吸窘迫综合征临床特点及预后危险因素分析

摘要

目的:分析心脏术后急性呼吸窘迫综合征(ARDS)临床特点及预后危险因素.方法:收集202例心脏术后发生ARDS患者的临床资料,将ARDS患者分为死亡组与存活组.分析比较两组患者术前、术中及术后各项相关因素的差别.结果:心脏术后ARDS的发生率为0.37％,病死率为29.7％.心脏术后ARDS患者平均年龄58.3岁,其中男性占67.3％.16％的ARDS患者为急诊手术,手术类型以单纯冠状动脉旁路移植术(CABG)、单纯瓣膜手术及大动脉手术为主.术后确诊ARDS的平均时间为2d.有创机械通气时间为6d,有50％的患者进行了二次插管,1/3的患者进行了二次甚至多次开胸手术,50％的患者出现了严重感染,病情最重期间出现了2～3个器官功能障碍.②单因素分析结果表明:死亡组与存活组相比,体质指数(BMI)低[(23.2±3.9)vs.(25.1±3.9)kg/m2,P =0.001]、术前HGB低[(122.3±16.2)vs.(129.1 ±22.6) g/L,P=0.035]、术后使用持续肾脏替代治疗(CRRT)比例高(46.7％ vs.26.8％,P=0.001)、气管插管时间长[232.0(92.8,360.0)vs.115.0(47.0,312.0)h,P=0.009]、术后严重感染发生比例高(60.0％ vs40.1％,P=0.010)、器官功能障碍数量多[(3.5±0.7)vs.(2.0±0.4),P=0.001].③多因素分析结果表明:BMI(HR:0.870,P=0.010)、术后严重感染(HR:2.464,P=0.022)及器官功能障碍数量(HR:5.762,P=0.000)为影响心脏术后ARDS预后的独立危险因素.结论:低BMI水平、术后严重感染及器官功能障碍数量多的ARDS患者预后较差.%Objective:To explore the clinical features of acute respiratory distress syndrome (ARDS) patients after cardiac surgery and the risk factors for prognosis.Methods:The retrospective study included 202 ARDS patients after cardiac surgeries that were divided into death group and survival group.The clinical features of the groups were collected.The clinical data in two groups of before surgery,during surgery and after surgery were compared.Results:① The incidence of ARDS after cardiac surgery was 0.37％,the mortality was 29.7％;The average age of ARDS after cardiac surgery was 58.3 years old,of which the male accounted for 67.3％;16％ of ARDS patients underwent emergency surgery,and the main types of surgery were coronary artery bypass grafting(CABG),simple valve surgery and major artery surgery;The time of diagnosis of ARDS was 2 days;The time of mechanical ventilation was 6 days,half of the patients had a second incubation;1/3 of the patients had thoracotomy more than twice;half of the patients had severe infection after surgery;2 to 3 organs dysfunction emerged during the most serious period.②Univariate analysis:The death group exhibited lower body mass index (BMI) [(23.2 ± 3.9) kg/m2 vs.(25.1 ± 3.9),P =0.001],lower hemoglobin before surgery [(122.3 ± 16.2) vs.(129.1 ± 22.6) g/L,P =0.035],higher proportion of continuous renal replacement therapy (CRRT) after surgery(46.7％ vs.26.8％,P =0.001),longer incubation time[232.0(92.8,360.0)vs.115.0(47.0,312.0)h,P =0.009],higher proportion of severe infection after surgery(60.0％ vs 40.1％,P =0.010) and more organs dysfunction[(3.5 ±0.7) vs.(2.0 ±0.4),P =0.001].③)Multivariate analysis:Lower BMI (HR =0.870,P =0.010),severe infection after surgery (HR =2.464,P =0.022) and more organs dysfunction(HR =5.762,P =0.000) were independent risk factors for ARDS.Conclusion:The patients of ARDS after cardiac surgery with lower BMI,severe infection after surgery and more organs dysfunction have a poor outcome.