论文部分内容阅读
目的探讨肾上腺皮质功能状态与急性呼吸窘迫综合征(ARDS)患者预后的关系。方法纳入2004年7月至2005年2月符合ARDS诊断标准的患者158例,以是否存活分为存活组和死亡组。静脉注射促肾上腺皮质激素250μg,放射免疫分析法测定注射前、注射后30 min及60 min血浆皮质醇水平(T0、T30及T60)。计算T30或T60的最大值与T0的差值(ΔTmax),以ΔTmax≤248．4 nmol／L作为相对肾上腺皮质功能不全的诊断标准。记录患者一般情况、急性生理和慢性健康(APACHEⅡ)评分、心率、呼吸、平均动脉压、氧合指数、动脉血pH、动脉血乳酸、血红蛋白、血小板和白细胞计数、功能衰竭器官个数和住院28 d病死率。结果158例患者中存活72例,死亡86例,28 d住院病死率为54．4％(86／158),相对肾上腺皮质功能不全发生率为42．7％(68／158)。死亡组患者相对肾上腺皮质功能不全发生率明显高于存活组(62．8％vs19．4％,P<0．01)。伴相对肾上腺皮质功能不全的ARDS患者病死率明显升高(76．5％vs36．8％,P<0．01)。ΔTmax判断预后的受试者操作曲线(ROC)下面积为0．655。Logistic多元回归分析显示功能衰竭器官数和相对肾上腺皮质功能不全是ARDS患者死亡的独立危险因素。结论肾上腺皮质功能状态对ARDS患者预后判断有指导价值。
Objective To investigate the relationship between the status of adrenal cortex and the prognosis of patients with acute respiratory distress syndrome (ARDS). Methods A total of 158 patients who met ARDS criteria from July 2004 to February 2005 were divided into survival group and death group. The level of plasma cortisol (T0, T30 and T60) before injection, 30 min and 60 min after injection were measured by radioimmunoassay. Calculate the difference between the maximum value of T30 or T60 and T0 (ΔTmax), with ΔTmax≤248.4 nmol / L as the diagnostic criteria for relative adrenocortical insufficiency. The patient’s general condition, APACHE II score, heart rate, respiration, mean arterial pressure, oxygenation index, arterial blood pH, arterial lactate, hemoglobin, platelet and white blood cell count, number of organ failure and hospitalization were recorded. d fatality rate. Results Of the 158 patients, 72 survived and 86 died. The 28-day in-hospital mortality rate was 54.4% (86/158) and the relative adrenocortical insufficiency rate was 42.7% (68/158). The incidence of relative adrenocortical insufficiency in the death group was significantly higher than that in the survival group (62.8% vs 19.4%, P <0.01). ARDS patients with relative adrenal insufficiency significantly increased mortality (76.5% vs36.8%, P <0.01). The area under the receiver operating curve (ROC) for ΔTmax to predict prognosis was 0.655. Logistic multiple regression analysis showed that the number of failing organs and relative adrenocortical insufficiency were independent risk factors for death in patients with ARDS. Conclusion The functional status of adrenal cortex has guiding value for the prognosis of patients with ARDS.