CLINICAL RISKS FOR DEVELOPMENT OF THE ACUTE RESPIRATORY-DISTRESS SYNDROME
CLINICAL RISKS FOR DEVELOPMENT OF THE ACUTE RESPIRATORY-DISTRESS SYNDROME
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DOI：
10.1164/ajrccm.151.2.7842182
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发表时间：
1995-02-01
影响因子：
24.7
通讯作者：
MAUNDER, RJ
中科院分区：
文献类型：
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作者：
HUDSON, LD;MILBERG, JA;MAUNDER, RJ
为了进一步了解急性呼吸窘迫综合征（ARDS）的流行病学，我们前瞻性地确定了1983年至1985年入住我们重症监护室的695例符合7项临床风险标准的患者，并随访了他们的ARDS发展和最终结局。695例患者中有179例（26%）发生ARDS。脓毒症综合征患者（75/176; 43%）和多次紧急输血（24 h内大于或等于15单位）患者（46/115; 40%）的ARDS发生率最高。在多发性创伤患者中，271例中有69例（25%）发展为ARDS。如果存在任何两种创伤的临床风险，则ARDS的发生率为57例中的23例，或40%。在研究期间，我们确定了48例ARDS患者，他们没有一个明确的临床风险，敏感性为79%（179/227）。与临床风险亚组中ARDS风险增加相关的次要因素包括脓毒症患者急性生理学和慢性健康评价II（APACHE II）评分升高，创伤患者APACHE II和损伤严重程度评分（ISS）升高。当存在ARDS时，死亡率（62%）是没有发生ARDS的临床风险患者（19%; p < 0.05）的3倍。如果发生ARDS，死亡率的差异在创伤患者中尤其显著（56%对13%），但在脓毒症患者中差异较小（69%对49%）。应谨慎解释死亡率数据，因为从收集这些数据时起，我们机构的ARDS患者死亡率似乎有所下降。在设计旨在预防或改变ARDS发展的研究时应考虑这些发现。
To further understanding of the epidemiology of acute respiratory distress syndrome (ARDS), we prospectively identified 695 patients admitted to our intensive care units from 1983 through 1985 meeting criteria for seven clinical risks, and followed them for development of ARDS and eventual outcome. ARDS occurred in 179 of the 695 patients (26%). The highest incidence of ARDS occurred in patients with sepsis syndrome (75 of 176; 43%) and those with multiple emergency transfusions (greater than or equal to 15 units in 24 h) (46 of 115; 40%). Of patients with multiple trauma, 69 of 271 (25%) developed ARDS. If any two clinical risks for trauma were present, the incidence of ARDS was 23 of 57, or 40%. During the study period, we identified 48 patients with ARDS who did not have one of the defined clinical risks, yielding a sensitivity of 79% (179 of 227). Secondary factors associated with increased risk for ARDS in clinical risk subgroups include an elevated Acute Physiologic and Chronic Health Evaluation II (APACHE II) score in patients with sepsis and increased APACHE II and injury Severity Scores (ISS) in trauma victims. Mortality was threefold higher when ARDS was present (62%) than among patients with clinical risks who did not develop ARDS (19%; p < 0.05). The difference in mortality if ARDS developed was particularly striking in patients with trauma (56% versus 13%), but less in those with sepsis (69% versus 49%). The mortality data should be interpreted with caution, since the fatality rate in ARDS patients appears to have decreased in our institution from the time that these data were collected. These findings should be considered in the design of studies aimed at preventing or modifying the development of ARDS.