【作者】 刘勇；

【导师】 崔乃强；

【作者基本信息】 天津医科大学 ， 中西医结合临床， 2009， 硕士

【摘要】 目的:观察本地区伴有急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）的腹部外科疾患原发病因和构成比、病死率,器官衰竭数目与病死率的关系、患者死亡的相关危险因素。方法:收集我院2004.1-2008.12年收治的符合标准的126例腹部外科疾病并发ALI/ARDS患者病例。按照统一的纳入和排除标准用统一设计的病例观察表收集患者的年龄、既往病史、器官衰竭数目、血PH值、PaO₂/FiO₂、白蛋白等临床资料,进行回顾性分析ALI/ARDS患者的临床资料。结果:回顾性分析可发现腹部外科疾病并发ALI/ARDS原发病因依次是胰腺炎,其他类（包括肿瘤、创伤、心肺复苏后等）、胆道感染性疾病、上消化道穿孔或出血、肠梗阻等。其中126例并发ALI/ARDS患者,死亡人数67人。病死率53.17%。本研究的单因素分析显示:年龄、既往病史、器官衰竭数目、PaO₂/FiO₂、白蛋白与ALI/ARDS患者病死率有显著性关系;且病死率随着受累器官数目的增加而增高,其中3个及以下器官衰竭者病死率为40.28%,3个以上为70.37%。经Logistic回归分析,年龄、器官衰竭数目,ALB为死亡的相关危险因素。结论:本课题通过对南开医院126例腹部外科疾病并发ALI/ARDS患者的临床资料进行回顾性分析得出,本研究中患者的总死亡率为53.17%,与国内外大多数研究结果相似。腹部外科疾病并发ALI/ARDS病死率仍较高,其中年龄、既往病史、器官衰竭数目、PaO₂/FiO₂、ALB与病死率密切相关。胰腺炎是我院腹部外科疾患并发ALI/ARDS的主要病因（55.38%）。腹部外科疾病并发ALI/ARDS患者病死率随着受累器官数目的增加而增高。抗休克治疗、配合“通里攻下”方药改善胃肠道功能,减轻胃肠屏障的破坏,积极纠正酸碱失衡、改善机体血氧含量及低蛋白血症,加强全身脏器功能支持,减少脏器受累数目,能改善预后。更多还原

【Abstract】 Objective To observe original etiologial factor and construction,mortality,the relation of organ failure numbers and mortality,risk factor of abdominal surgery disease that associate with Acute Lung Injury/Acute Respiratory Distress Syndrome.Methods To collect the record of 126 patients who appeared Acute Lung Injury /Acute Respiratory Distress Syndrome in our hospital from 2004.1 to 2008.12. According to unified inclusion and exclusion standard,collect clinical date of patients by unitied observational table and study retrospectively,including age,Past history, Organ failure,PH value,PaO₂/FiO₂,albumin and so on.Result The original cause of ALI/ARDS were acute pancreatitis,shock,post of abdominal operation and cardiopulmonary resuscitation,tauma,Biliary tract infection,upper gastrointestinal perforation and bleeding,Intestinal obstruction and so on.The mortality of 53.17%was high in 126 patients.Our study showed that those with age,Past history,Organ failure,PaO2/FiO2,albumin had a relatively higher mortatily by single factor analysis.The more organs of being involved in were,the higher mortality was.The mortality of less than 4,and above 3 organs of being involved in was 40.28%,70.37%,respectively.After logistic regression analysis,the main risk factors were age,the number of organ failure,PaO₂/FiO₂,albumin.Conlusion By retrospective study the date of 126 patients with ALI/ARDS post of abdominal operation,the mortatily is 53.17%.It is mostly similar with internal and external research.The mortality of ALI/ARDS was still high.The main risk factors were age,the number of organ failure,PaO2/FiO2,albumin,acute pancreatitis is main causes of ALI/ARDS in our hospital（51.59%）.In order to improve prognosis, we should strengthen antishock,improve gastrointestinal function and reduce the damage of gastrointestinal barrier with the "TongLiGongXia" prescriptions,correct acid-base imbalance,improve the oxygen content of the body and hypoproteinemia in treatment,reinforced organ function support,reduced organ failure numbers.更多还原