Navarrete-Navarro Pedro, Rivera-Fernández Ricardo, Rincón-Ferrari Ma Dolores, García-Delgado Manuel, Muñoz Angeles, Jiménez Jose Manuel, Ortega F J Fernández, García Dolores Ma Mayor
Virgen de las Nieves University Hospital, Granada, Spain.
J Crit Care. 2006 Sep;21(3):253-8. doi: 10.1016/j.jcrc.2005.12.012.
The aim of the study was to identify early risk factors for development of acute respiratory distress syndrome (ARDS) in severe trauma patients.
This was a prospective observational study of 693 severe trauma patients (Injury Severity Score >or=16 and/or Revised Trauma Score <or=11) in 17 hospitals in a Spanish region of 8 million inhabitants from July 2002 to December 2002.
Acute respiratory distress syndrome developed in 6.9% of patients who were more severely ill with higher APACHE II (P < .001) and Injury Severity Score (P = .002) scores vs patients not developing ARDS. Acute respiratory distress syndrome development was associated (P < .001) with fractures of femur (International Classification of Diseases, Ninth Revision [ICD-9] codes 820, 821), tibia (ICD-9 code 823), humerus, and pelvis, with a number (>or=2) of long bone fractures, and with chest injuries (rib/sternal fracture [ICD-9 code 807] and hemo/pneumothorax [ICD-9 code 860/861]). Patients with ARDS required more colloids (P = .005) and red blood cell units (P = .02) than patients without ARDS during the first 24 hours. Multivariate analysis showed that ARDS was related to chest trauma diagnosis (ICD-9 code 807) (odds ratio [OR], 3.85), femoral fracture (OR, 3.16), APACHE II score (OR, 1.05), and blood transfusion during resuscitation (OR, 1.32).
Risk of ARDS development is related to the first 24-hour admission variables, including severe physiologic derangements and specific ICD-9-classified injuries. Blood transfusion may play an independent role.
本研究旨在确定严重创伤患者发生急性呼吸窘迫综合征（ARDS）的早期危险因素。
这是一项对2002年7月至2002年12月期间西班牙一个拥有800万居民地区的17家医院的693例严重创伤患者（损伤严重度评分≥16和/或修订创伤评分≤11）进行的前瞻性观察研究。
与未发生ARDS的患者相比，发生ARDS的患者病情更重，急性生理学及慢性健康状况评分系统II（APACHE II）（P <.001）和损伤严重度评分（P =.002）更高，其中6.9%的患者发生了急性呼吸窘迫综合征。急性呼吸窘迫综合征的发生与股骨骨折（国际疾病分类第九版[ICD-9]编码820、821）、胫骨骨折（ICD-9编码823）、肱骨骨折、骨盆骨折、多处（≥2处）长骨骨折以及胸部损伤（肋骨/胸骨骨折[ICD-9编码807]和气胸/血胸[ICD-9编码860/861]）相关（P <.001）。在最初24小时内，发生ARDS的患者比未发生ARDS的患者需要更多的胶体液（P =.005）和红细胞单位（P =.02）。多因素分析显示，ARDS与胸部创伤诊断（ICD-9编码807）（比值比[OR]，3.85）、股骨骨折（OR，3.16）、APACHE II评分（OR，1.05）以及复苏期间输血（OR，1.32）有关。
ARDS发生风险与入院后最初24小时的变量有关，包括严重的生理紊乱和ICD-9分类的特定损伤。输血可能起独立作用。
