【摘要】 目的:探索呼吸功能正常患者接受机械通气治疗发生急性呼吸窘迫综合征(ARDS)的危险因素。方法:回顾分析自2002年—2007年间接受通气治疗超过48h的患者资料,比较入住时呼吸功能正常患者是否发生ARDS之间的不同。结果:共有823例患者接受了超过48h的机械通气治疗。其中751例患者符合入选标准,接受机械通气治疗时临床上排除充血性心功能衰竭,明确无ARDS存在,但在随后的治疗期间139例最后发生ARDS。单因素回归分析表明高吸气峰压(相对危险度OR值1.70,可信区间CI1.41～2.07),PEEP(相对危险度OR值1.76,可信区间CI1.45～2.14)和潮气量(相对危险度OR值1.07,可信区间CI1.06～1.10)增加是显著危险因素。非机械通气相关的因素包括脓毒血症,低pH值,低白蛋白,血浆,高净液体输入和低呼吸顺应性。多元回归分析表明机械通气相关因素PEEP及潮气量影响ARDS。而峰气道压,平台压均与ARDS无关。结论:机械通气设置等因素潮气量及PEEP与ARDS密切相关。合理设置参数可以一定程度上预防部分患者发生ARDS。更多还原

【Abstract】 Objective:To explore the risk factors for patients receiving mechanical ventilation to develop ARDS.Method:Patients who received mechanical ventilation more than 48 hours between 2001 and 2007 were retrospective analyzed.The variables that influenced the development of ARDS were compared and analyzed.Result:There were 823 patients who accepted mechanical ventilation more than 48 hours.751 of these patients who did not have ARDS at hospital admission meet the inclusion criteria.ARDS developed in 139 patients(19%)at last.Univariate analysis revealed high peak inspiratory pressure(odds ratio [OR],1.70 per SD;95% confidence interval [CI],1.41 to 2.07),increasing positive end-expiratory pressure(OR,1.76 per SD;95% CI,1.45 to 2.14)and VT(OR 1.07 per SD;95% CI,1.06 to 1.10)to be significant risk factors.Other risk factors for ARDS not related to ventilation included sepsis,low pH,elevated lactate,low albumin,transfusion of packed RBCs,transfusion of plasma,high net fluid balance,and low respiratory compliance.Multivariable logistic regression analysis showed that risk factors for ARDS related to mechanical ventilator included positive end expiratory pressure(OR,0.06 per Unit)and tidal volume(OR 1.57 per SD).Conclusion:Positive end expiratory pressure and the setting of mechanical ventilation were close related to the development of ARDS.Reasonable setting the parameter of mechanical ventilation may prevent the ADRS in a certain extent.更多还原