Crit Care:急性低氧血症性呼吸衰竭和急性呼吸窘迫综合征患者的死亡原因和特征

2020-07-13 MedSci原创 MedSci原创

急性低氧血症性呼吸衰竭(AHRF)和急性呼吸窘迫综合征(ARDS)与高院内死亡率相关。但是,在1990年代的ARDS患者队列中,患者死于败血症或多器官功能衰竭而不是难治性低氧血症更为常见。在过去的25

急性低氧血症性呼吸衰竭(AHRF)和急性呼吸窘迫综合征(ARDS)与高院内死亡率相关。但是,在1990年代的ARDS患者队列中,患者死于败血症或多器官功能衰竭而不是难治性低氧血症更为常见。在过去的25年中,由于越来越多的人关注肺保护通气和败血症的治疗,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,研究人员假设当代患者队列的死亡原因可能有所不同。这些差异可以为临床医生提供治疗干预的参考。

研究人员在单个三级医疗中心确定了(2016-2017年)住院的成年患者,AHRF定义为PaO2/FiO2≤300,同时接受有创机械通气≥12h,并在住院期间死亡。多位医师根据柏林定义裁定有无ARDS。不了解ARDS状况的独立摘要员使用标准化工具收集了有关器官功能障碍和撤消生命支持的数据。死亡的主要原因被定义为最直接导致死亡或撤消生命支持的器官系统。

研究人员确定了385名患有AHRF的死者,其中127名(33%)患有ARDS。最常见的死亡原因是败血症(26%)、肺功能不全(22%)和神经系统功能不全(19%)。死亡时多器官衰竭的发生率为70%,最常见的原因是败血症(占所有患者的50%),死亡时有70%的患者需要呼吸支持。只有2%的患者无需吸氧或通气。85%的患者在停止生命支持后死亡。ARDS患者更常以肺功能障碍为主要死亡原因(28% vs. 19%;p=0.04),并且在需要大量呼吸支持的情况下更容易死亡(82% vs. 64%;p<0.01)。

在这个当代的AHRF患者队列中,最常见的死亡原因是败血症和肺功能障碍。绝大多数死亡发生在撤离生命支持后。与没有ARDS的患者相比,ARDS患者更有可能以肺功能障碍为主要死亡原因,同时需要大量的呼吸支持。

原始出处:

Scott W. Ketcham.et al.Causes and characteristics of death in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: a retrospective cohort study.Critical Care.2020.https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03108-w

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    积分

    0

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    2020-07-13 lovetcm

    #急性呼吸窘迫综合征#对于急性呼吸窘迫综合症的治疗,现在也需要反思。

    0

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