Clinical Analysis Of Risk Factors And Treatment Interventions For The Prognosis Of Acute Respiratory Distress Syndrome

Objective:①To investigate the clinic risk factors influencing the outcomes of patients with ARDS.②To investigate the treatment efficiency of acute respiratory distress syndrome, with the application of direct invasive ventilation and forced invasive ventilation after the failure of non-invasive positive pressure ventilation.Methods:The clinical data of145patients come from QiLu Hospital intensive care unite (ICU), from January2008to January2011, were retrospectively analyzed. Patients were divided into survivor group (n=80) and non-survivor group (n=65) according to the patiens prognostic. Respectively choosing the Predisposing factors of ARDS, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, simple acute physical score (SAPS), the number of organ dysfunction, sepsis severity, ARDS originating from pulmonary disease (ARDSp) and extrapulmonary disease (ARDSexp), the first three days fluid management, Mechanical ventilation strategy, Invasive ventilation days, Total ventilation days, the application of anticoagulants to analysis the patients prognosis, Days of hospitalization in ICU, Prognosis, Total hospitalization days; The clinical data of ARDS patients with the application of direct Ⅳ and NIPPV-Ⅳ were retrospectively analyzed from137ARDS patients. Results:①The univariate analysis showed that age (P<0.001), the differences in APACHE Ⅱ scores (P<0.001), SOFA scores (P=0.003), the number of organ dysfunction (P<0.001), the severity of sepsis (P<0.001), ARDSp and ARDSexp (P=0.043), the first three days fluid management(P=0.02) and the application of anticoagulants (P=0.006) were significant between survivor group and non-survivor group. Logistic regression analysis showed that APACHE Ⅱ (P=0.016, OR:1.095,95%CI:1.017～1.1.179), the severity of sepsis (P<0.001, OR:2.559,95%CI:1.609～4.072), ARDSp and ARDSexp (P=0.033, OR:0.348,95%CI:0.131～0.920) were the independent predictor of the mortality in patients with ARDS.②Direct Ⅳ group was90patients and NIPPV-IV group was47patients, the analysis showed that sexual, age, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores, sequential organ failure assessment (SOFA) scores, simple acute physical (SAP Ⅱ) scores, lung injury scores, the original of ARDS, sepsis severity were no significant between direct IV group and NIPPV-Ⅳ group (p>0.05), after the different mechanical ventilation, the the number of organ dysfunction, treatment days in ICU and mortality were significant between direct Ⅳ group and NIPPV-Ⅳ group (p<0.05).Conclusion:①The risk factors of affecting the prognosis of ARDS patiens is multiple, the APACHE II scores, severity of sepsis, original of ARDS are the independent predictors of the mortality in patients with ARDS.②ARDS patients should be established artificial airway directly for the application of invasive ventilation, NIPPV should be used with caution in ARDS patients in order to avoid poor prognosis by its failure.