Sloane P J, Gee M H, Gottlieb J E, Albertine K H, Peters S P, Burns J R, Machiedo G, Fish J E
Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107.
Am Rev Respir Dis. 1992 Aug;146(2):419-26. doi: 10.1164/ajrccm/146.2.419.
In a multicenter registry conducted over 2 yr of patients with acute respiratory distress syndrome (ARDS), we enrolled 153 patients and collected data daily for 7 consecutive days and weekly thereafter until death or hospital discharge. The purposes of the registry were (1) to determine whether a more liberal definition of ARDS (PaO2/FIO2 < or = 250; bilateral pulmonary infiltrates within 7 days) than those commonly used would result in enrollment of patients earlier in their clinical course, and (2) to study the clinical course of the syndrome in survivors and nonsurvivors. The mortality rate was 54% and it was significantly greater in older versus younger patients (75% versus 37%) and in septic versus nonseptic patients (60% versus 43%). We found that the definition of ARDS used for the registry resulted in enrollment of patients 1 to 7 days earlier than was the case when other published definitions of ARDS were applied to the patient population. Fewer than 2% of the patients failed to meet one of the nonregistry definitions of ARDS within 7 days. The mortality rate was independent of the definition used to identify ARDS patients. Our results suggest that a more liberal definition of ARDS than those commonly used can result in identification of the same population of patients earlier in their clinical course.
在一项针对急性呼吸窘迫综合征（ARDS）患者进行的为期2年的多中心登记研究中，我们纳入了153例患者，连续7天每天收集数据，此后每周收集一次，直至患者死亡或出院。该登记研究的目的是：（1）确定与常用定义相比，更宽松的ARDS定义（动脉血氧分压/吸入氧分数值≤250；7天内双侧肺部浸润）是否能使患者在临床病程中更早入组；（2）研究该综合征在幸存者和非幸存者中的临床病程。死亡率为54%，老年患者（75%）高于年轻患者（37%），脓毒症患者（60%）高于非脓毒症患者（43%）。我们发现，该登记研究中使用的ARDS定义使患者入组时间比将其他已发表的ARDS定义应用于该患者群体时提前1至7天。不到2%的患者在7天内未符合非登记研究的ARDS定义中的任何一项。死亡率与用于识别ARDS患者的定义无关。我们的结果表明，与常用定义相比，更宽松的ARDS定义可使相同患者群体在临床病程中更早被识别。
