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題 名 | 加護病房內急性呼吸窘迫症候群的探討=Survey of Acute Respiratory Distress Syndrome in Intersive Care Unit |
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作 者 | 李俊德; 陶宏洋; 李錦中; 李琳; | 書刊名 | 胸腔醫學 |
卷 期 | 13:1 1998.03[民87.03] |
頁 次 | 頁1-6 |
分類號 | 415.47 |
關鍵詞 | 急性呼吸窘迫症候群; 加護病房; Acute respiratory distress syndrome; Intensive care unit; |
語 文 | 中文(Chinese) |
中文摘要 | 急性呼吸窘迫症候群定義採用1994年歐美聯合研討會結論的診斷標準:1.急性發作2.氧合指數(PaO�砥�FiO�砥^小或等於200毫米汞柱(不論使用吐氣末正壓值大小)3.胸部Ⅹ光呈現兩側肺浸潤4.肺動脈楔壓若有測量,須小或等於18毫水汞柱,若無資料,則以臨床上無左心房高壓現象即可。 本研究屬前瞻性,凡年度內在高雄榮民總醫院所有加護病中病患,依上述標準診斷為急性呼吸窘迫症候群者,即列為研究追蹤對象。結果顯示:1.全院加護病房計62床,全年急性呼吸窘迫症候群病患共87人,男女比例55╱32。其中成人病患69人,平均年齡60歲;小兒病患18人,平均年齡8個月。2.急性呼吸窘迫症候群病患雖僅佔所有加護病房住院人數2.7%,但加護病房內住院日數卻佔了所有病患住院日數7.1%,平均住院日數為所有病患2.6倍,存活率則只有全部病患的35%。3.急性呼吸窘迫症候群病患離開加護病房時的存活率29.9%,離開醫院時的存活率23.0%,二者在小兒病患皆遠高於成人病患。4.引起急性呼吸窘迫症候群的原因在成人部份以感染佔60.9%最多,其次為創傷10.1%、休克7.2%;小兒則以早產起因佔55.6%居首,其次為感染16.7%、窒息11.1%。5.診斷急性呼吸窘迫症候群時,病患的氧合指數平均值為104.8毫米汞柱,肺動脈楔壓平均值11.6毫米汞柱。6.加護病房內平均使用呼吸器日數、初用通氣型態及曾經使用過的特殊通氣方式或藥物在成人及小兒組間有顯著不同,使用吐氣末正壓最高值在小兒病患偏低。7.加護病房內非存活病患住院最終的資料分析,小 病患有較異常的動脈血液氣體數值,成人病患則有較高的腎功能異常值。8.出院時存活病患與非存活病患相比較,是否為感染起因在兩組間有意義差別。 |
英文摘要 | The definition of acute respiratory distress syndrome (ARDS), recommended by The American-European Consensus Conference on ARDS held in 1994, included 1) Acute onset, 2) PaO��/FiO�砥�200 mm Hg (regardless of PEEP level), 3) Bilateral infiltrates seen on frontal chest radiograph, 4) Pulmonary artery wedge pressure ≦18 mm Hg when measured or no clinical evidence of left atrial hypertension. We prospectively screened all the intensive-care-unit (ICU) patients in Veterans General Hospital-kaohsiung from 1996-1-1 to 1996-12-31. A total of 87 patients were diagnosed as ARDS, 55 male and 32 female. The median age was 60 years in 69 adult patients and 8 months in 18 pediatrics. The incidence of ARDS in ICU was 2.7%, and the ICU hospital-day in ARDS was 7.1% of all ICU patients. Survival rate of ARDS in ICU was 29.9%, but there only 23.0% patients survived when discha-rging from hospital. The major causes of ARDS in adult patients were infection (60.9%), trauma (10.1%) and shock 7.2%); the causes in pediatrics were premature (55.6%), infection (16.7%) and asphyxia (11.1%) The mean PaO��/FiO�� was 104.8 mmHg and pul-monary artery wedge pressure was 11.6 mmHg when when ARDS was diagnosed. The ventilatory modes, sedation and specific medication used in ICU for ARDS patients had marked difference between adult and pediatric groups. Most of the pediatric patients died of oxygenation failure, but multiple system organ dysfunction was common in adult mortal patients. We conclude that the survival rate of ARDS is low and more work-up is necessary for improving the prognosis. |
本系統中英文摘要資訊取自各篇刊載內容。