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目的:探讨柏林标准对急性呼吸窘迫综合征(ARDS)的预后判断价值。方法:回顾性分析96例ARDS患者的临床资料,入科首日留取桡动脉血检测氧合指数,并根据氧合指数分为3个亚组。主要研究截点为:7d、28d存活情况并记录死亡患者生存天数;次要观察截点为:入科首日、3d呼吸模式、ICU住院时间及总住院时间。结果:7d观察截点提示轻度组死亡5例(15.2%),中度组死亡9例(19.1%),重度组死亡5例(31.3%),3个亚组生存率比较差异无统计学意义(χ2=1.76,P>0.05);28d观察截点提示轻度组死亡10例(30.3%),中度组死亡17例(36.2%),重度组死亡12例(75.0%),3个亚组生存率比较差异有统计学意义(χ2=9.68,P<0.05)。3组死亡患者生存天数/中位数类似[(7.52±6.5)/5vs.(7.70±7.2)/5vs.(10.75±8.25)/9,χ2=1.08/1.78,P>0.05)]。通气模式方面,首日3个亚组患者分布基本相似(χ2=1.43,P>0.05),但3d时分布情况差异有统计学意义(χ2=12.94,P<0.05);相较于首日,轻度组接受鼻导管吸氧、有创通气比例均有所增加(12.1%/18.2%,45.5%/69.7%),中度组无创、有创通气比例有所增加(19.1%/29.8%,34.0%/61.7%),重度组接受有创通气比例则为最高(62.6%/93.8%)。ICU住院时间及总住院时间组间比较差异无统计学意义(P>0.05)。结论:BD标准将轻度组纳入诊断范围,有助于早期识别,扩大预警效应,分层方法对远期生存率具有可比性,重度组需更早地采取及时有效的干预措施。
Objective: To investigate the prognostic value of Berlin criteria for acute respiratory distress syndrome (ARDS). Methods: The clinical data of 96 patients with ARDS were retrospectively analyzed. Radiographic indices of oxygenation were collected on the first day of admission and divided into three subgroups according to the oxygenation index. The main study cut-off points were: survival on day 7 and day 28, and survival days of patients who died were recorded. The secondary observation intercepts were respiratory pattern, ICU stay time and total length of hospital stay on the first day of admission. Results: The results of 7 days observation showed that there were 5 deaths in mild group (15.2%), 9 deaths (19.1%) in moderate group and 5 death cases (31.3%) in severe group. There was no significant difference in survival rate among the 3 subgroups (Χ2 = 1.76, P> 0.05). The cut-off point at 28 days indicated that 10 cases (30.3%) died in mild group, 17 cases (36.2%) died in moderate group, 12 cases (75.0%) died in severe group and 3 Subgroup survival rates were significantly different (χ2 = 9.68, P <0.05). The survival days / median of death in 3 groups were similar [(7.52 ± 6.5) /5vs. (7.70 ± 7.2) /5vs. (10.75 ± 8.25) /9,χ2=1.08/1.78, P> 0.05)]. Ventilation mode, the distribution of patients in the three subgroups on the first day was similar (χ2 = 1.43, P> 0.05), but the difference was statistically significant at 3d (χ2 = 12.94, P <0.05) In the mild group, nasal catheter was used for oxygen inhalation, the proportion of invasive ventilation was increased (12.1% / 18.2%, 45.5% / 69.7%). The moderate group was noninvasive and invasive ventilation was increased (19.1% / 29.8% 34.0% / 61.7%), while the rate of invasive ventilation in the severe group was the highest (62.6% / 93.8%). ICU length of stay and hospital stay were no significant difference between groups (P> 0.05). Conclusion: The BD standard incorporates the mild group into the diagnosis range, which is helpful for the early identification and expansion of the early warning effect. The stratification method is comparable to the long-term survival rate, and the severe group needs to take timely and effective interventions.