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目的比较肺部原因诱发的急性呼吸窘迫综合征(acute respiratory distress syndrome of pulmonary origin,ARDSp)和肺外原因诱发的ARDS(ARDS of extra-pulmonary origin,ARDSexp)临床特征差异性。方法对2001-2002年上海市15个成人重症监护病房(intensive care unit,ICU)前瞻性调查确诊的108例ARDS(ARDSp 41例和ARDSexp 67例)患者进行年龄、性别、基础疾病、危险因素、疾病危重程度以及预后等因素分析比较。结果ARDSp和ARDSexp组患病率(以同期ICU收治危重病例为基数)分别为0.77%和1.26%,ARDSexp组显著高于ARDSp(P=0.012)。ARDSp患者以肺炎最多见,占肺部原因的90.2%;ARDSexp较多见的是急性重症胰腺炎,占22.4%。ARDSp与ARDSexp患者之间在人选时肺损伤评分分别为2.6分和2.4分,APACHEⅡ评分分别为20.1分和17.8分,差异无统计学意义(P分别为0.281和0.267)。住ICU时间分别为15.5d和15.9d(P=0.896);机械通气时间分别为9.5d和9d(P=0.770)。住院期间病死率分别为78.0%及62.7%(P=0.095)。但两组患者主要死亡原因都是多脏器功能衰竭和呼吸衰竭。结论虽然ARDSexp组患病率显著高于ARDSp,但两组患者在疾病严重程度、病死率以及主要死亡原因等方面差异无统计学意义。
Objective To compare the clinical features of acute respiratory distress syndrome (ARDSp) induced by pulmonary causes and ARDS (extraneous pulmonary origin) induced by extrapulmonary causes (ARDSexp). Methods One hundred and eighty patients with ARDS (41 ARDSp and 67 ARDSexp) diagnosed by prospective investigation in 15 adult intensive care units (ICU) in Shanghai from 2001 to 2002 were divided into three groups according to age, gender, underlying diseases, risk factors, Disease severity and prognosis and other factors analysis and comparison. Results The prevalences of ARDSp and ARDSexp groups were 0.77% and 1.26% respectively, and ARDSexp group was significantly higher than ARDSp group (P = 0.012). ARDSp patients with the most common pneumonia, accounting for 90.2% of lung causes; ARDSexp more common acute severe pancreatitis, accounting for 22.4%. Lung injury scores were 2.6 and 2.4 on ARDSp and ARDSexp, respectively, and APACHE II scores were 20.1 and 17.8, respectively, with no significant difference (P = 0.281 and 0.267, respectively). The duration of ICU stay was 15.5d and 15.9d, respectively (P = 0.896). The duration of mechanical ventilation was 9.5d and 9d respectively (P = 0.770). Mortality rates during hospitalization were 78.0% and 62.7%, respectively (P = 0.095). However, the main causes of death in both groups were multiple organ failure and respiratory failure. Conclusion Although the prevalence of ARDSexp was significantly higher than that of ARDSp, there was no significant difference between the two groups in disease severity, mortality and the main causes of death.