脓毒症相关急性呼吸窘迫综合征患者患者临床特征与预后

摘要

Objective The aim of this study was to investigate the factors that influenced the outcomes of the patients with sepsis induced ARDS due to the failure in implementing series care bundles. Methods In this retrospective study performed in general ICU at Qilu hospital, al consecutively admit ed adult (≥18 years) patients who need invasive mechanical ventilation (MV)≥ 48 h from January, 2008 through December, 2010 were included and the patient data analyzed by trained intensivists. Results The 1268 patients enrolled, 96 patients with sepsis induced ARDS were eligible for inclusion criteria during the study period. In both group patients, delayed admission to general ICU was a common problem, ARDS mainly origined from infectious pneumonia due to multi-drug resistance pathogens, lower tidal volume and PEEP was adopted during mechanical ventilation. Compared with survivors group, non-survivor patients were elder, higher baseline disease severity scores and proportion of medical disease, lower PaO2/FiO2 and higher peak airway pressure, higher occurrence of septic shock which resulted in risen incidence of acute kidney injury, more daily fluid accumulation and higher proportion of CRRT performance. Conclusion The compliance of the implementation of critical care bundles was bad, and worsen the patients outcomes.%目的研究影响脓毒症相关急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)患者临床特征和影响其预后的因素。方法回顾分析2008年1月~2010年12月入住综合ICU患者符合脓毒症相关ARDS患者资料，分为存活组和死亡组。结果研究期间共有1268例患者入住综合ICU，96例患者符合脓毒症相关ARDS，其中存活组49例，死亡组47例。普遍存在入住ICU延迟和多重耐药菌导致肺部感染。与存活组比较，死亡组患者以高龄、基础疾病重、内科疾病、机械通气期间不改善氧和功能、高气道峰压，感染性休克和急性肾损伤发生率高、持续性血液滤过(CRRT)和液体正平衡为主。结论对重症医学相关指南依从性不高是导致脓毒症相关ARDS患者死亡率居高不降的重要因素APACHEⅡ评分、脓毒症严重程度、ARDS来源，是影响ARDS患者预后的独立危险因素。