弥漫性肺泡损伤增加急性呼吸窘迫综合征患者的死亡风险

沈剑.弥漫性肺泡损伤增加急性呼吸窘迫综合征患者的死亡风险[J].内科急危重症杂志,2021,27(3):220-223

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DOI：10.11768/nkjwzzzz20210311

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作者	单位	E-mail
沈剑	成都市第三人民医院（成都市呼吸健康研究所）呼吸与危重症医学科	sjfy12@163.com

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中文摘要:

目的：研究弥漫性肺泡损伤（DAD）与急性呼吸窘迫综合征（ARDS）患者死亡率的相关性。方法：回顾性分析2016年1月-2019年12月成都市第三人民医院20例接受开放式肺活检（OLB）的ARDS患者的病例资料。依次分析ARDS患者的基本特征及病理诊断，将存活者与死亡者资料进行对比分析。根据有无肺泡弥漫性损伤将患者分成2组：DAD组和非DAD组，对比分析人口学和临床特征；对医院死亡率相关临床变量进行logistic回归分析。结果：ARDS患者病理诊断中11例诊断为DAD，其中7例仅有DAD，4例有DAD合并其他疾病。9例诊断为非DAD，其中4例被归类为感染，3例为肺间质型，2例被归类为混合感染复杂性疾病；存活组和死亡组在开胸肺活检当天的序贯性器官衰竭评估（SOFA）评分和氧合指数（PaO2/FiO2）比值比较，差异有统计学意义（P＜0.01或P＜0.05），有ARDS且病理诊断为DAD的患者死亡率明显高于无DAD患者（P＜0.01）；logistic回归分析显示，ARDS患者DAD的发生率（比值：3.554，95%CI：1.385，9.120；P＜0.01）和活检日SOFA评分（比值：1.424，95%CI：1.187，1.707；P＜0.01）与医院死亡率显著独立相关。结论：DAD-ARDS 患者PaO2/FiO2低、高SOFA 评分,更易死于难治性低氧血症,而非休克；难治性休克是无DAD患者主要死因。DAD患者的预后比无DAD患者差。DAD发生率与ARDS患者死亡率显著相关。

英文摘要:

Objective: To study the relationship between diffuse alveolar damage (DAD) and mortality in patients with acute respiratory distress syndrome (ARDS). Methods: The case data of 20 ARDS patients who underwent open lung biopsy (OLB) in Chengdu Third People's Hospital from January 2016 to December 2019 were retrospectively analyzed. The basic characteristics and pathological diagnoses of ARDS patients were analyzed sequentially, and the data of survivors and non-survivors were compared and analyzed. According to whether DAD existed, the patients were divided into two groups: DAD group and non-DAD group. Then demographic and clinical features were compared, and the logistic regression analysis was performed on clinical variables related to hospital mortality. Results: In the pathological diagnosis of ARDS patients, 11 cases were diagnosed as DAD, of which 7 cases only had DAD, and 4 cases had DAD combined with other diseases. A total of 9 cases were diagnosed as non-DAD, of which 4 cases were classified as infections, 3 cases as pulmonary interstitial type, and 2 cases as mixed infection complex diseases. There was significant difference in sequential organ failure assessment (SOFA) score and oxygenation index (PaO2/FiO2) ratio between the survivors group and the non-survivors group on the day of thoracotomy lung biopsy (P< 0.01 or P< 0.05). The mortality of patients with ARDS and pathologically diagnosed as DAD was significantly higher than that in those without DAD (P< 0.01). Logistic regression analysis showed the incidence of DAD in patients with ARDS (ratio: 3.554, 95% CI: 1.385, 9.120; P< 0.01) and SOFA score on the day of thoracotomy lung biopsy (ratio: 1.424, 95% CI: 1.187, 1.707; P< 0.01) was significantly and independently correlated with hospital mortality. Conclusion: DAD-ARDS patients with low PaO2/FiO2 and high SOFA scores are more likely to die of refractory hypoxemia rather than a shock and refractory shock is the main cause of death in patients without DAD. The prognosis of patients with DAD is worse than that of patients without DAD. The incidence of DAD is significantly related to the mortality of ARDS patients.