急性呼吸窘迫综合征合并肺部感染患者预后影响因素研究
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摘要
目的探讨急性呼吸窘迫综合征合并肺部感染患者预后及影响因素,为其临床研究提供参考依据。方法选取2014年10月-2016年10月收治的568例急性呼吸窘迫综合征患者为研究对象,收集患者的性别、年龄、体质量、基础疾病等基本资料,对患者治疗期间发生的肺部感染病例情况进行分析,单因素及多因素Logstic回归分析医院感染患者预后的影响因素。结果 568例急性呼吸窘迫综合征患者中肺部感染患者113例,感染率为19.89%;113例肺部感染患者共检出病原菌199株,其中革兰阳性菌41株占20.60%,革兰阴性菌148株占74.37%,真菌10株占5.03%;113例急性呼吸窘迫综合征合并肺部感染患者中病死77例,病死率为68.14%;通过单因素和Logistic回归方程证实年龄、住院时间、通气时间和氧合指数是影响患者预后的独立影响因素(P<0.05)。结论急性呼吸窘迫综合征患者的肺部感染情况较为严重,患者感染后的预后效果不佳,病死率较高,患者年龄、治疗时机、氧合指数是导致患者预后不佳的影响因素。
OBJECTIVE To explore the influencing factors for prognosis of the acute respiratory distress syndrome patients complicated with pulmonary infection so as to provide guidance for clinical research.METHODS A total of568 patients with acute respiratory distress syndrome who were treated from Oct 2014 to Oct 2016 were recruited as the study objects,the baseline data of the patients,including gender,age,body weight and underlying diseases,were statistically analyzed,the number of the patients who had pulmonary infection during the treatment was analyzed,and the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the prognosis of the patients.RESULTS Of the 568 patients with acute respiratory distress syndrome,113 had pulmonary infection,with the infection rate 19.89%.Totally 199 strains of pathogens were isolated from the 113 patients with pulmonary infection,41(26.19%)of which were gram-positive bacteria,148(69.84%)were gram-negative bacteria,and 10(3.97%)were fungi.Of the 113 acute respiratory distress syndrome patients complicated with pulmonary infection,77 died,with the mortality rate 68.14%.The results of the univariate analysis and logistic regression analysis indicated that the age,length of hospital stay,mechanical ventilation duration and oxygenation index were the independent influencing factors for the prognosis of the patients.CONCLUSION The pulmonary infection is severe in the patients with acute respiratory distress syndrome,the patients with the infection have poor prognosis,with the mortality rate high.The age,timing of treatment and oxygenation index are the influencing factors for the poor prognosis.It is necessary to take targeted intervention measures according to the influencing factors in clinical practice so as to reduce the mortality rate.
OBJECTIVE To explore the influencing factors for prognosis of the acute respiratory distress syndrome patients complicated with pulmonary infection so as to provide guidance for clinical research.METHODS A total of568 patients with acute respiratory distress syndrome who were treated from Oct 2014 to Oct 2016 were recruited as the study objects,the baseline data of the patients,including gender,age,body weight and underlying diseases,were statistically analyzed,the number of the patients who had pulmonary infection during the treatment was analyzed,and the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the prognosis of the patients.RESULTS Of the 568 patients with acute respiratory distress syndrome,113 had pulmonary infection,with the infection rate 19.89%.Totally 199 strains of pathogens were isolated from the 113 patients with pulmonary infection,41(26.19%)of which were gram-positive bacteria,148(69.84%)were gram-negative bacteria,and 10(3.97%)were fungi.Of the 113 acute respiratory distress syndrome patients complicated with pulmonary infection,77 died,with the mortality rate 68.14%.The results of the univariate analysis and logistic regression analysis indicated that the age,length of hospital stay,mechanical ventilation duration and oxygenation index were the independent influencing factors for the prognosis of the patients.CONCLUSION The pulmonary infection is severe in the patients with acute respiratory distress syndrome,the patients with the infection have poor prognosis,with the mortality rate high.The age,timing of treatment and oxygenation index are the influencing factors for the poor prognosis.It is necessary to take targeted intervention measures according to the influencing factors in clinical practice so as to reduce the mortality rate.
引文
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[2] Cavalcanti AB,Suzumura EA,Laranjeira LN,et al.Effect of lung recruitment and titrated positive end-expiratory pressure(PEEP)vs low PEEP on mortality in patients with acute respiratory distress syndrome:a randomized clinical trial[J].JAMA,2017,318(14):1335-1345.
[3] Thille AW,Penuelas O,Lorente JA,et al.Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome:a retrospective analysis of clinical autopsies[J].Crit Care,2017,21(1):254.
[4] Wang LP,Mao QH,Yang L.Effect of pulmonary surfactant combined with mechanical ventilation on oxygenation functions and expressions of serum transforming growth factorbeta1(TGF-β1)and bone morphogenetic protein 7(BMP-7)of neonatal respiratory distress syndrome[J].Eur Rev Med Pharmacol Sci,2017,21(19):4357-4361.
[5] ARDS Definition Task Force,Ranieri VM,Rubenfeld GD,et al.Acute respiratory distress syndrome:the Berlin definition[J].JAMA,2012,307(23):2526-2533.
[6]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[7]季明霞,斯小水,何建新,等.乌司他丁联合持续血液净化治疗对急性呼吸窘迫综合征患者肺血管内皮通透性的影响研究[J].中国全科医学,2015,18(6):688-691.
[8] Pu S,Wang D,Liu D,et al.Effect of sivelestat sodium in patients with acute lung injury or acute respiratory distress syndrome:a meta-analysis of randomized controlled trials[J].BMC Pulm Med,2017,17(1):148.
[9] Buke B,Destegul E,Akkaya H,et al.Prediction of neonatal respiratory distress syndrome via pulmonary artery Doppler examination[J].J Matern Fetal Neonatal Med,2017,17:1-6.
[10] Wu MY,Huang CC,Wu TI,et al.Is there a preinterventional mechanical ventilation time limit for candidates of adult respiratory extracorporeal membrane oxygenation[J].ASAIO J,2017,63(5):650-658.
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