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急性呼吸窘迫综合征:发病率、临床病程及护理费用

Acute respiratory distress syndrome: frequency, clinical course, and costs of care.

作者信息

Valta P, Uusaro A, Nunes S, Ruokonen E, Takala J

机构信息

Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Finland.

出版信息

Crit Care Med. 1999 Nov;27(11):2367-74. doi: 10.1097/00003246-199911000-00008.

Abstract

OBJECTIVE

To define the occurrence rate of acute respiratory distress syndrome (ARDS) using established criteria in a well-defined general patient population, to study the clinical course of ARDS when patients were ventilated using a "lung-protective" strategy, and to define the total costs of care.

DESIGN

A 3-yr (1993 through 1995) retrospective descriptive analysis of all patients with ARDS treated in Kuopio University Hospital.

SETTING

Intensive care unit in the university hospital.

PATIENTS

Fifty-nine patients fulfilled the definition of ARDS: Pao2/Fio2 <200 mm Hg (33.3 kPa) during mechanical ventilation and bilateral infiltrates on chest radiograph.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

With a patient data management system, the day-by-day data of hemodynamics, ventilation, respiratory mechanics, gas exchange, and organ failures were collected during the period that Pao2/Fio2 ratio was <200 mm Hg (33.3 kPa). The frequency of ARDS was 4.9 cases/100,000 inhabitants/yr. Pneumonia and sepsis were the most common causes of ARDS. Mean age was 43+/-2 yrs. At the time of lowest Pao2/Fio2, the nonsurvivors had lower arterial and venous oxygen saturations and higher arterial lactate than survivors, whereas there were no differences between the groups in other parameters. Multiple organ dysfunction preceded the worst oxygenation in both the survivors and nonsurvivors. The intensive care mortality was 37%; hospital mortality and mortality after a minimum 8 months of follow-up was 42%. The most frequent cause of death was multiple organ failure. The effective costs of intensive care per survivor were US $73,000.

CONCLUSIONS

The outcome of ARDS is unpredictable at the time of onset and also at the time of the worst oxygenation. Keeping the inspiratory pressures low (30-35 cm H2O [2.94 to 3.43 kPa]) reduces the frequency of pneumothorax, and might lower the mortality. Most patients are young, and therefore the costs per saved year of life are low.

摘要

目的

采用既定标准确定在明确界定的普通患者群体中急性呼吸窘迫综合征(ARDS)的发生率,研究采用“肺保护性”策略对ARDS患者进行通气时的临床病程,并确定护理总成本。

设计

对库奥皮奥大学医院1993年至1995年3年间所有ARDS患者进行回顾性描述性分析。

地点

大学医院的重症监护病房。

患者

59例患者符合ARDS定义:机械通气期间动脉血氧分压/吸入氧分数值(Pao2/Fio2)<200 mmHg(33.3 kPa)且胸部X线片显示双侧浸润影。

干预措施

无。

测量指标及主要结果

通过患者数据管理系统,在Pao2/Fio2比值<200 mmHg(33.3 kPa)期间收集血流动力学、通气、呼吸力学、气体交换和器官功能衰竭的每日数据。ARDS的发生率为4.9例/100,000居民/年。肺炎和脓毒症是ARDS最常见的病因。平均年龄为43±2岁。在Pao2/Fio2最低时,非幸存者的动脉和静脉血氧饱和度低于幸存者,动脉乳酸水平高于幸存者,而两组在其他参数上无差异。在幸存者和非幸存者中,多器官功能障碍均先于最严重的氧合障碍出现。重症监护病房死亡率为37%;医院死亡率和至少随访8个月后的死亡率为42%。最常见的死亡原因是多器官功能衰竭。每位幸存者的重症监护有效成本为73,000美元。

结论

ARDS在发病时以及最严重氧合障碍时的预后均不可预测。保持吸气压力较低(30 - 35 cm H2O [2.94至3.43 kPa])可降低气胸发生率,并可能降低死亡率。大多数患者较为年轻,因此挽救每一年生命的成本较低。

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