|本期目录/Table of Contents|

[1]郭晓芳,梁培,陈鸣,等.腹膜炎患者术后急性呼吸窘迫综合征的临床特点及危险因素分析[J].医学研究与战创伤救治(原医学研究生学报),2020,22(6):603-607.[doi:10.3969/j.issn.1672-271X.2020.06.010]
　GUO Xiao-fang,LIANG Pei,CHEN Ming,et al.Features and risk factors analysis of early postoperative acute respiratory distress syndrome in patients with acute peritonitis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(6):603-607.[doi:10.3969/j.issn.1672-271X.2020.06.010]
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腹膜炎患者术后急性呼吸窘迫综合征的临床特点及危险因素分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第22卷
期数:
2020年6期
页码:
603-607
栏目:
临床研究
出版日期:
2020-11-20

文章信息/Info

Title:
Features and risk factors analysis of early postoperative acute respiratory distress syndrome in patients with acute peritonitis
作者:
郭晓芳; 梁培; 陈鸣; 尤勇; 张北源; 虞文魁; 王妍
作者单位：210008南京，南京大学医学院附属鼓楼医院重症医学科（郭晓芳、陈鸣、尤勇、张北源、虞文魁、王妍），药学部（梁培）
Author(s):
GUO Xiao-fang1;  LIANG Pei2;  CHEN Ming1;  YOU Yong1;  ZHANG Bei-yuan1;  YU Wen-kui1; WANG Yan1
(1.Department of Intensive Care Unit, 2. Department of Pharmacy, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu, China)
关键词:
急性呼吸窘迫综合征; 急性腹膜炎; 危险因素; 手术后并发症; 临床特点
Keywords:
acute respiratory distress syndrome;  acute peritonitis;  risk factors; postoperative complications; clinical characteristics
分类号:
R536.8
DOI:
10.3969/j.issn.1672-271X.2020.06.010
文献标志码:
A
摘要:
目的探讨急性腹膜炎患者手术后早期急性呼吸窘迫综合征（ARDS）的临床特点及危险因素。方法回顾性分析南京大学医学院附属鼓楼医院重症医学科（ICU）2016年7月1日至2018年12月31日行急诊手术的急性腹膜炎162例患者临床资料，根据患者术后72 h内是否发生ARDS分为ARDS组和非ARDS组，收集患者基本信息、基础生理指标、实验室检查、术中及术后因素等，进行单因素分析和Logistic回归分析以探求腹膜炎患者术后ARDS发生的危险因素。结果162例急性腹膜炎患者手术后早期ARDS发病率 24.07%（39例）。与非ARDS组相比，ARDS组患者APACHE Ⅱ评分、SOFA评分、血白细胞、乳酸、术中液体平衡、出血量、输血及休克、去甲肾上腺素剂量＞0.1 μg/（kg·min）差异均有统计学意义（P＜0.05）。Logstic多因素回归分析提示：SOFA评分（OR=1.730，95%CI=1.356～2.205，P=0.000）、术中液体平衡（OR=1.002，95%CI=1.000～1.003，P=0.028）、输血（OR=0.119，95%CI=0.017～0.830，P=0.032）、休克（OR=0.224，95%CI=0.054～0.919，P=0.038）及去甲肾上腺素剂量＞0.1 μg/(kg·min)（OR=9.044，95%CI=1.158～70.632，P=0.036）为影响急性腹膜炎患者手术后发生ARDS的危险因素。ARDS组患者ICU住院时间[(6.12±5.51)d]、机械通气时间[(58.59±65.82)h]及30 d病死率(15.38%)明显高于非ARDS组[(3.20±2.75)d、(13.75±14.91)h、4.07%,P＜0.05]，2组肺炎发生率比较差异无统计学意义（P>0.05）。结论ARDS是急性腹膜炎手术后常见的并发症，其中SOFA评分、术中液体平衡、输血、休克及去甲肾上腺素剂量＞0.1 μg/(kg·min)是急性腹膜炎患者早期发生ARDS的危险因素。
Abstract:
ObjectiveTo discuss the features and risk factors of postoperative acute respiratory distress in the patients with acute abdomen surgery.MethodsA total of 162 patients admitted to intensive care unit (ICU) from July 2016 to December 2018 were included in the study. The patients were assigned into the acute respiratory distress syndrome (ARDS) group and non-ARDS group. The basic information, physiological indicators and laboratory examinations, intraoperative and postoperative factors were collected for univariate analysis and logistic regression to explore the risk factors for ARDS in patients with peritonitis.ResultsThe overall incidence of ARDS was 24.07%（39 cases）. Univariate analysis revealed that there were significant differences in APACHE Ⅱ score,SOFA score, leukocyte count, blood lactate concentration, total fluid balance, blood products, shock, infusion of norepinephrine ＞0.1 μg/(kg·min) (P＜0.05). The variables were found to be significantly related to ARDS by Logistic regression: SOFA score (OR=1.730；95%CI=1.356-2.205；P=0.000), total fluid balance (OR=1.002；95%CI=1.000-1.003；P=0.028), blood products (OR=1.002；95%CI=1.000-1.003；P=0.028), shock (OR=0.224；95%CI=0.054-0.919；P=0.038), infusion of norepinephrine ＞0.1 μg/(kg·min) (OR=9.044；95%CI=1.158-70.632；P=0.036). The ICU duration time [(6.12±5.51)d], mechanical ventilation time [(58.59±65.82)h] and 30-d mortality rate (15.38%) of the ARDS group were statistically higher than those in non-ARDS group [(3.20±2.75)d , (13.75±14.91)h, 4.07%, all P＜0.05)]. There was no significant difference in the incidence of pneumonia between the two groups (P>0.05).ConclusionARDS is a common complication after surgery with acute peritonitis. This study shows that SOFA score, total fluid balance, blood products, shock, infusion of norepinephrine ＞0.1.

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备注/Memo

备注/Memo:
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更新日期/Last Update: 2020-12-01