摘要
目的评价血管外肺水指数(EVLWI)对急性呼吸窘迫综合征(ARDS)患者预后的预测价值。方法选取2013年解放军第一八七中心医院收治的68例ARDS患者,根据21 d后临床转归分为存活组42例和死亡组26例。所有患者进入ICU后采用呼吸机进行容量控制通气,连续3 d监测患者血气分析指标、氧合指数、乳酸水平、平均动脉压(MAP)、中心静脉压(CVP)、心排血指数(CI)及脉搏指示连续心排血量(Pi CCO),计算EVLWI。结果两组患者置管第1天EVLWI、氧合指数、MAP、CVP、CI、乳酸水平,置管第2天MAP、CVP、CI、乳酸水平,置管第3天MAP、CVP比较,差异均无统计学意义(P>0.05);死亡组患者置管第2天、第3天EVLWI高于存活组,氧合指数低于存活组;死亡组患者置管第3天CI、乳酸水平高于存活组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,EVLWI与氧合指数呈负相关(r=-0.52,P<0.05),而与MAP(r=-0.12,P=0.17)、CVP(r=-0.19,P=0.30)、CI(r=-0.14,P=0.25)、乳酸(r=-0.21,P=0.44)间无直线相关性。急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分预测ARDS患者预后的曲线下面积(AUC)为(0.71±0.08)〔95%CI(0.57,0.83)〕;置管第1天、第2天、第3天EVLWI预测ARDS患者预后的AUC分别为(0.44±0.07)〔95%CI(0.28,0.66)〕、(0.65±0.06)〔95%CI(0.50,0.79)〕、(0.74±0.08)〔95%CI(0.61,0.87)〕,EVLWI>8.0 ml/kg为预测ARDS患者预后不良的最佳临界值,此时的灵敏度为84.2%,特异度为57.5%。结论 EVLWI为评价肺毛细血管渗漏的指标之一,对ARDS患者预后有一定预测价值。
Objective To evaluate the prognostic value of extravascular lung water index（ EVLWI） in patients with acute respiratory distress syndrome（ARDS）. Methods A total of 68 patients with ARDS were selected in the 187th Hospital of People′s Liberation Army in 2013,and they were divided into survival group（n=42）and death group（n=26）according to the 21 - day clinical outcome. All of the patients were given volume controlled ventilation, and blood gas analysis index, oxygenation index（ OI）,lactic acid（ LA）,mean arterial pressure（ MAP）,central venous pressure（ CVP）,cardiac output index（ CI）,pulse indicated continuous cardiac output（ PiCCO） were monitored during the following 3 days,and EVLWI was＂nbsp;calculated. Results No statistically significant differences of EVLWI, OI, MAP, CVP, CI, LA 1 day after cathetering, MAP,CVP,CI,LA 2 days after cathetering,MAP,CVP 3 days after cathetering between the two groups（P〉0. 05）;while EVLWI of death group was higher than that of survival group,OI was lower lower than that of survival group,2,3 days after cathetering,respectively（P〈0. 05）;CI and LA of death group were higher than those of survival group 3 days after cathetering （P〈0. 05）. Pearson correlation analysis showed that,EVLWI was negatively correlated with OI（r = -0. 52,P 〈0. 05）, while no linear correlation was found with MAP（r= -0. 12,P=0. 17）,CVP（r= -0. 19,P=0. 30）,CI（r= -0. 14,P=0. 25）or LA（r= -0. 21,P=0. 44）. The AUC of APACHEⅡ score was（0. 71 ± 0. 08）〔95%CI（0. 57,0. 83）〕in predicting the prognosis of ARDS,that of EVLWI 1 day,2 days,3 days after cathetering was（0. 44 ± 0. 07） 〔95%CI （0. 28,0. 66）〕,（0. 65 ± 0. 06）〔95%CI（0. 50,0. 79）〕,（0. 74 ± 0. 08）〔95%CI（0. 61,0. 87）〕,respectively;EVLWI〉8. 0 ml/kg was the best critical value in predicting bad prognosis of ARDS, and the sensitivity was 84. 2%, the specificity was 57. 5%. Conclusion EVLWI is an index for evaluating the pulmonary capillary leakage,can be used to predict the prognosis of ARDS.
出处
《实用心脑肺血管病杂志》
2015年第3期66-68,共3页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
急性呼吸窘迫综合征
成人
血管外肺水
氧合指数
预后
Respiratory distress syndrome, adult
Extravascular lung water
Oxygen index
Prognosis
