【摘要】 目的调查北京地区重症监护病房(ICU)中急性呼吸窘迫综合征(ARDS)的病死率及其影响因素。方法采用1992年欧美ARDS联席会议提出的ARDS诊断标准,回顾性调查1998年5月-2003年4月北京地区8所三级综合性医院ICU中收治的年龄>12岁、持续ICU治疗超过24h的ARDS患者。结果 8482例患者中383例发生ARDS(4.5%),其中肺源性97例、肺外源性286例。脓毒症(21.7%)、肺炎(16.2%)、大手术(13.1%)、重症胰腺炎(12.8%)及严重创伤(10.7%)为ARDS最常见的原发病。ARDS总病死率52.0%,以APACHEⅡ评分对病死率进行调整,调整后5年间病死率无显著变化(P=0.085)。多因素分析显示,ARDS死亡危险因素有年龄、基础疾病、多器官功能障碍及住院时间。脓毒性休克(36.2%)与心功能衰竭(20.6%)是ARDS主要死亡原因,仅14.6%患者死于呼吸衰竭。结论 ARDS是北京地区ICU中的常见危重症,死亡率仍较高,且近年来未下降。脓毒性休克与心功能衰竭是ARDS主要死亡原因。更多还原

【Abstract】 Objective To investigate the mortality and risk factors in outcome of acute respiratory distress syndrome (ARDS) in intensive care units (ICU) in Beijing. Methods ARDS patients,aged above twelve,admitted to ICUs of eight general hospitals in Beijing from May 1998 to Apr. 2003,and stayed in ICU for longer than 24h,were retrospectively studied. ARDS was diagnosed according to the 1992 American-European Consensus Conference criteria. Results Of 8482 patients admitted to ICUs,383 (4.5%) developed ARDS. Among them,97 cases were pulmonary originated and 286 cases were nonpulmonary originated. The primary diseases of ARDS were mainly sepsis (21.7%),pneumonia (16.2%),major operation (13.1%),serious pancreatitis (12.8%) and severe trauma (10.7%). The overall mortality of ARDS was 52.0%. When the mortality rate was adjusted with APACHE Ⅱ (acute physiology and chronic health evaluation Ⅱ) score,no significant change in mortality was found in 5 years (P=0.085). Multivariate analysis identified the following risk factors:age,chronic disease,multiple organ dysfunction and length of stay in ICU. Septic shock (36.2%) and heart failure (20.6%) were the major causes of death,while only 14.6% patients died of respiratory failure. Conclusions ARDS is a critical disorder which occurs frequently in ICUs in Beijing with persistent higher mortality. Septic shock and heart failure are the major causes leading to death.更多还原