【摘要】 目的 探讨急性呼吸窘迫综合征（acute respiratory distress syndrome,ARDS）患者早期进展的高危因素，为早期发现ARDS进展的高危患者并进行早期干预提供参考。方法 对来自多中心临床研究项目中接受机械通气的轻中度ARDS患者数据进行回顾分析，根据机械通气72 h内ARDS严重程度分级是否进展为下一级分为早期进展组和非进展组，采用χ2检验进行组间比较，采用Logistic回归分析ARDS患者进展的高危因素并比较两组患者的预后情况。结果 共纳入有创机械通气的轻中度ARDS患者355例，其中72 h进展的患者97例（27.3%）；进展组男性占78.4%，非进展组男性占64.0%；进展组ARDS患者较非进展组ARDS的28天无机械通气时间更短、重症监护病房（intensive care unit,ICU）病死率更高、30天及60天患者存活率更低（P<0.05），但两组患者的ICU住院时间无明显差异（P>0.05）。单因素及多因素回归分析显示进展组ARDS患者基线氧合指数较低[比值比（odds ratio,OR）=0.979,95%置信区间（confidential interval,CI）0.961～0.986,P<0.01]、气道峰压较高（OR=1.068,95%CI 1.017～1.121,P<0.01）、乳酸水平较高（OR=1.224,95%CI 1.057～1.417,P<0.01）、潮气量较高（OR=1.159,95%CI 1.002～1.341）, P<0.05）、年龄较大（OR=1.373,95%CI 1.051～1.082,P<0.01），男性患者更多（OR=2.583,95%CI 1.336～4.995,P<0.05）。结论 接受机械通气的轻中度ARDS患者早期进展常见，进展组较非进展组28天无机械通气时间更短、ICU病死率更高、30天及60天存活率更低。男性、较低的基线氧合指数水平、高气道峰压、潮气量、乳酸水平和年龄较大是轻中度ARDS患者早期进展的危险因素。更多还原

【Abstract】 Objective To investigate the risk factors for early progression in patients with acute respiratory distress syndrome(ARDS), and to provide a reference for early detection and intervention of high-risk patients with ARDS progression. Methods Data from multicenter mechanically ventilated patients with mild to moderate ARDS were retrospectively analyzed. According to the severity grade of 72 h ARDS, the patients were divided into an early progressive group and a non-progressive group. Chi-square test was used to compare the risk factors of ARDS patients and the prognosis of the two groups were analyzed by Logistic regression. Results A total of 355 patients with mild to moderate ARDS were included in invasive mechanical ventilation, of which 97 patients(27.3%) progressed after 72 hours. 78.4%were female in the progressive group and 64.0% were female in the non-progressive group. Compared with the nonprogressive group, the patients with ARDS in the progressive group had shorter 28-day no mechanical ventilation, higher ICU mortality, and lower survival rate at 30 days and 60 days(P<0.05), but there was no significant difference in the length of ICU stay between the two groups(P>0.05). Univariate and multivariate regression analysis showed that the patients with ARDS in the progressive group had lower baseline oxygenation index(OR=0.979, 95%CI 0.961-0.986,P<0.01), higher peak airway pressure(OR=1.068, 95%CI 1.017-1.121, P<0.01), higher lactate level(OR=1.224, 95%CI1.057-1.417, P<0.01), higher tidal volume(OR=1.159, 95%CI 1.002-1.341, P<0.05), higher age(OR=1.373, 95%CI 1.051-1.082, P<0.01), and more male patients(OR=2.583, 95%CI 1.336-4.995, P<0.05). Conclusions Early progression is common in mild to moderate ARDS patients with mechanical ventilation. The progressive group has shorter duration of28 days without mechanical ventilation, higher ICU mortality and lower 30-day and 60-day survival rate than the nonprogressive group. Male, low baseline oxygenation index levels, high peak airway pressure, tidal volume, lactate levels, and higher age are risk factors for early progression in patients with mild to moderate ARDS.更多还原