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目的:探索呼吸功能正常患者接受机械通气治疗发生急性呼吸窘迫综合征(ARDS)的危险因素。方法:回顾分析自2002年—2007年间接受通气治疗超过48h的患者资料,比较入住时呼吸功能正常患者是否发生ARDS之间的不同。结果:共有823例患者接受了超过48h的机械通气治疗。其中751例患者符合入选标准,接受机械通气治疗时临床上排除充血性心功能衰竭,明确无ARDS存在,但在随后的治疗期间139例最后发生ARDS。单因素回归分析表明高吸气峰压(相对危险度OR值1.70,可信区间CI1.41～2.07),PEEP(相对危险度OR值1.76,可信区间CI1.45～2.14)和潮气量(相对危险度OR值1.07,可信区间CI1.06～1.10)增加是显著危险因素。非机械通气相关的因素包括脓毒血症,低pH值,低白蛋白,血浆,高净液体输入和低呼吸顺应性。多元回归分析表明机械通气相关因素PEEP及潮气量影响ARDS。而峰气道压,平台压均与ARDS无关。结论:机械通气设置等因素潮气量及PEEP与ARDS密切相关。合理设置参数可以一定程度上预防部分患者发生ARDS。
Objective: To explore the risk factors of acute respiratory distress syndrome (ARDS) in patients with normal respiratory function undergoing mechanical ventilation. Methods: The data of patients who received ventilation for more than 48 hours from 2002 to 2007 were retrospectively analyzed. The differences of ARDS among patients with normal respiratory function at admission were compared. Results: A total of 823 patients underwent mechanical ventilation for more than 48 hours. Of these, 751 patients met the inclusion criteria and were clinically excluded from congestive heart failure during mechanical ventilation, with no evidence of ARDS, but 139 eventually developed ARDS during subsequent treatment. Univariate regression analysis showed that high peak inspiratory pressure (relative risk OR 1.70, confidence interval CI 1.41-2.07), PEEP (relative risk OR 1.76, confidence interval CI 1.45-2.14) and tidal volume The relative risk of OR 1.07, credible CI1.06 ~ 1.10) increase is a significant risk factor. Non-mechanical ventilation related factors include sepsis, low pH, low albumin, plasma, high net fluid input, and low respiratory compliance. Multivariate regression analysis showed that mechanical ventilation related factors PEEP and tidal volume affect ARDS. The peak airway pressure, platform pressure and ARDS have nothing to do. Conclusion: Mechanical ventilation settings and other factors tidal volume and PEEP and ARDS are closely related. Proper setting of parameters can prevent ARDS in some patients to a certain extent.