Crit Care:教学医院与非教学医院急性呼吸窘迫综合征患者的预后相同吗?

2017-05-30 xing.T MedSci原创

由此可见,与大学医院相比,非大学医院ARDS患者的死亡风险显著增高。在医院之间的通气护理的差异可能解释这一发现。

近日,危重病医学领域权威杂志Critical Care上发表了一篇研究文章,研究人员旨在评估德国教学和非教学医院对进行机械通气的急性呼吸窘迫综合征(ARDS)患者治疗和结局的差异。

这项前瞻性、观察性队列研究旨在确定死亡率相关的独立危险因素,通过评估以下因素:基线因素、呼吸机的设置(例如,驱动压力)、并发症、病房情况,例如通气量患者的病例容量、ICU的类型/大小和医院的类型(教学/非教学医院)。为了控制在ARDS发病时潜在的混杂因素以及验证死亡率的差异,研究人员使用了额外的多变量分析比较了大学与非大学医院的ARDS患者。

在2004年5月,18教学医院和62个非教学医院的95个ICUs入住了7540例患者,其中,1028例患者进行了机械通气,198例患者发展成为ARDS。尽管ARDS患者的特征非常相似,医院的死亡率在大学医院中是相当的低,相比于非教学医院(39.3% vs. 57.5%;P=0.012  )。在非教学医院治疗与死亡率增加独立相关(比值比(95%可信区间)为:2.89(1.31-6.38);P=0.008)。当将ARDS发病时的混杂因素进行控制时,两组患者之间的相互独立比较证实了这一点。更高的驱动压力(每增加1cmH2O比值比为1.10)也与更高的死亡率独立相关。与非教学医院相比,大学医院在治疗性机械通气时应用了较高的呼气末正压(PEEP)(平均±SD:11.7±4.7 vs. 9.7±3.7cmH2O;P=0.005)和较低的驱动压力(15.1±4.4 vs. 17±5cmH2O;P=0.02),并且通气时间延长一倍(中位数(IQR):16(9-29)vs. 8(3-16)天;P < 0.001)。

由此可见,与教学医院相比,非教学医院ARDS患者的死亡风险显著增高。在医院之间的通气护理的差异可能解释这一发现。

原始出处:


Konstantinos Raymondos,et al. Outcome of acute respiratory distress syndrome in university and non-university hospitals in Germany.Critical Care.2017. https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1687-0

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    2017-05-31 1e1b8538m79(暂无匿称)

    这个应该是有所差别的

    0

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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEIsrUxHnicsiaqwzJibCks60HOicbEAgbNzUiciboMJDzsWg16OHTeNHhyYvTg6TDXTlOx7icnhttCYYe2ujYt0yND7dYusOsibl9XnQCE/0, createdBy=7ad21722200, createdName=jaysppr, createdTime=Tue May 30 12:11:38 CST 2017, time=2017-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=204390, encodeId=ec0120439041, content=教学与实践结合, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/05/25/aee510ed68ce4736e9fe4ec7d03c01b1.jpg, createdBy=ce892064652, createdName=楠博One, createdTime=Tue May 30 10:30:07 CST 2017, time=2017-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=204384, encodeId=b7eb20438480, content=学习了很多的事情,, beContent=null, objectType=article, channel=null, level=null, 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    2017-05-30 明天会更好!

    学习过了,值得分享!

    0

  5. 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    2017-05-30 tanxingdoctor

    学习啦谢谢分享

    0

  6. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/MnthNYiaYT4SNKeEmLuaew8INxnWjegguR2tEB5XL37oicS1HFZDejzeXjjFpdPVZ2VaLzXibdTXkkPRuj4YVQkTg/132, createdBy=76cb105999, createdName=穆慕仁真, createdTime=Tue May 30 09:35:08 CST 2017, time=2017-05-30, status=1, ipAttribution=)]
    2017-05-30 jaysppr

    感谢梅斯医学!!

    0

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    2017-05-30 楠博One

    教学与实践结合

    0

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    2017-05-30 胖红

    学习了很多的事情,

    0

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    2017-05-30 1e1b8538m79(暂无匿称)

    不错的文章,值得学习

    0

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    2017-05-30 穆慕仁真

    医疗护理水平的差异

    0

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在ARDS的治疗上辛伐他汀被认为是具有成本效益,并与显著的QALY增益和成本节省相关。12个月的死亡率没有显著减少。

Thorax:内源性线粒体甲酰肽在急性呼吸窘迫综合征中的作用!

该研究首次提供了确凿的证据表明线粒体甲酰肽在人类疾病中发挥作用,并且证实了它在ARDS患者表达有所增加,以及在肺损伤的小鼠模型中发挥重要作用。这项工作揭示了线粒体甲酰肽FPR1信号作为无菌性急性肺损伤的关键驱动因素,并且可以作为ARDS的潜在治疗靶点。

Thorax:急性呼吸窘迫综合征患者不同生物学表型的聚类分析!

ARDS患者可分为两种生物学表型,其病死率有所不同,并且这四种生物标志物可准确地预测表型。

Intens Care Med:急性呼吸窘迫综合征患者需不需要他汀类药物治疗?

研究人员发现在成年ARDS患者中,无论是整体或预定义的亚组中,开始他汀类药物治疗均没有临床效益。虽然血清肌酸激酶和转氨酶水平升高的发生率增加,但是组间严重不良事件无明显差异。因此,该研究不建议对ARDS患者使用他汀类药物治疗。

Crit Care:小小微粒竟然可以预测是否发生ARDS!

此前,有研究表明,急性呼吸窘迫综合征(ARDS)患者的微粒(MP)浓度升高与凝血活化有关。体外研究表明MPs有助于急性肺损伤,但是ARDS患者循环中MPs的意义尚未得到充分研究。近期,一项发表在杂志Crit Care上的研究进行了一项假设,即循证MPs水平升高可以预测发展为ARDS的危重病人,并且循环MPs的水平与临床结果相关。此项研究从确诊为急性肺损伤生物标志物(VALID)队列研究中选择了28

Intens Care Med:ARDS幸存者的医疗资源利用与费用如何?

这项多中心的纵向研究发现40%的ARDS幸存者在出院后12个月随访期间至少报告了一次住院。很少患者或ICU相关指标与住院相关。但是,在随访在6个月后的身体、精神和生活质量指标与后续住院相关。以减少ARDS后疾病的干预措施在改善患者预后和降低医疗成本上可能是很重要的。