重症病毒性肺炎合并急性呼吸窘迫综合征预后危险因素探讨

摘要

目的：探讨影响重症病毒性肺炎合并急性呼吸窘迫综合征患者预后的因素。方法回顾性分析重症病毒性肺炎合并急性呼吸窘迫综合征患者77例临床资料，根据患者住院期间是否死亡分为死亡组和存活组，比较2组的临床特征，分析影响重症病毒性肺炎合并急性呼吸窘迫综合征预后的危险因素。结果多器官功能障碍综合征（MODS，35．7％）、感染性休克（28．6％）和呼吸衰竭（14．3％）是导致死亡的主要因素。死亡组和存活组患者在年龄、ICU住院时间、肺泡－动脉氧分压差（ A－aDO2）、机械通气时间、起病至确诊时间、APACHEH评分、MODS评分、氧合指数（FiO2）、血清尿素氮（BUN）、血清肌酐（Scr）、C反应蛋白（CRP）、血小板和降钙素原（PCT）指标上差异具有统计学意义（ P＜0．05）；起病至确诊时间、APACHEH评分、A－aDO2、FiO2和年龄均为影响患者预后的独立危险因素（P＜0．05）。结论起病至确诊时间、APACHEH评分、A－aDO2、FiO2和年龄为独立影响重症病毒性肺炎合并急性呼吸窘迫综合征患者预后的因素。%Objective To investigate the factors that influence the prognosis of severe viral pneumonia patients with acute respiratory distress syndrome .Methods A retrospective analysis was performed using clinical data from 77 severe viral pneumonia patients with acute respiratory distress syndrome .These patients were divided into a death group and a survival group according to their conditions during hospitalization .Both groups were compared for clinical characteristics , while the risk factors about their prognosis were analyzed .Results Multiple organ dysfunction syndrome ( MODS) , sep-tic shock and respiratory failure were the leading causes of death .The death group and the survival group showed signifi-cant difference in age, ICU length of stay, A-aDO2, duration of mechanical ventilation, time of onset to diagnosis, APACHEH score, MODS score, oxygenation index, BUN, Scr, CRP, platelets and PCT (P<0.05).The time of onset to diagnosis, APACHEⅡscore, A-aDO2, oxygenation index and age were independent prognostic factors (P<0.05). Conclusion The time of onset to diagnosis , APACHEⅡscore, A-aDO2 , oxygenation index and age are the independ-ent prognostic factors for severe viral pneumonia patients with acute respiratory distress syndrome .