摘要
目的探讨肺泡动脉氧分压差[P(A-a)O 2]用于急性呼吸窘迫综合征(ARDS)的分层诊断及指导治疗的价值。方法选取该院2016年6月至2019年5月入住重症监护病房(ICU)的社区获得性肺炎致ARDS患者,患者分为轻度ARDS组(A组)、中度ARDS组(B组)及重度ARDS组(C组),比较各组间在诊断ARDS时P(A-a)O 2、氧合指数(OI)及急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)评分的差异,分析P(A-a)O 2与OI及APACHEⅡ评分的相关性,绘制受试者工作特征(ROC)曲线分析P(A-a)O 2预测中度ARDS及重度ARDS的截断值,用P(A-a)O 2的截断值对ARDS进行危险分层,比较各层之间病情危重程度的差异。结果A组P(A-a)O 2低于B组,B组P(A-a)O 2低于C组(P<0.01),P(A-a)O 2与OI、APACHEⅡ评分相关(P<0.01)。P(A-a)O 2预测中度ARDS的ROC曲线下面积(AUC)为0.906(0.848,0.963),截断值为176.5,灵敏度为81.80,特异度为84.40,P(A-a)O 2预测重度ARDS的AUC为0.878(0.813,0.943),截断值为198.3,灵敏度为97.00,特异度为73.80。P(A-a)O 2的截断值进行危险分层后的APACHEⅡ评分差异均有统计学意义(P<0.01)。结论P(A-a)O 2可以用于ARDS患者分层诊断与指导治疗。
Objective To explore the value of alveolar artery oxygen partial pressure differenceP(A-a)O 2 in hierarchical diagnosis of acute respiratory distress syndrome(ARDS)and guidance treatment.Methods The patients with ARDS caused by community-acquired pneumonia in ICU of this hospital from June 2016 to May 2019 were selected and divided into the mild ARDS group(A),moderate ARDS group(B)and severe ARDS group(C).The differences of P(A-a)O 2,OI and APACHEⅡscores in diagnosing ARDS were compared among the groups.The correlation between P(A-a)O 2 with OI and APACHEⅡscore was analyzed.The cutoff value of P(A-a)O 2 for predicting moderate ARDS and severe ARDS was analyzed by drawing the receiver-operating characteristic(ROC)curve.The cutoff value of P(A-a)O 2 was used to conduct the risk stratification for ARDS.The differences of severity of illness were compared among different levels.Results P(A-a)O 2 of the group A was lower than of the group B,and the group B was lower than the group C(P<0.01),P(A-a)O 2 was correlated to OI and APACHEⅡscores(P<0.01).AUC of P(A-a)O 2 for predicting moderate ARDS was 0.906(0.848,0.963),the cutoff value was 176.5,the sensitivity was 81.80,the specificity was 84.40.AUC of P(A-a)O 2 for predicting severe ARDS was 0.878(0.813,0.943),the cutoff value was 198.3,the sensitivity was 97.00,the specificity was 73.80.After using the cutoff value of P(A-a)O 2 to conduct the risk stratification,the difference of APACHEⅡscores had statistical significance(P<0.01).Conclusion P(A-a)O 2 can be used for the hierarchical diagnosis and guide the treatment in the patients with ARDS.
作者
王灵
王万灵
刘雪晖
WANG Ling;WANG Wanling;LIU Xuehui(Department of Intensive Care Unit,People′s Hospital of Qiandongnan Miao and Dong Autonomous Prefecture,Kaili,Guizhou 556000,China;Department of Emergency,People′s Hospital of Qiandongnan Miao and Dong Autonomous Prefecture,Kaili,Guizhou 556000,China)
出处
《重庆医学》
CAS
2020年第5期750-753,共4页
Chongqing medicine
基金
黔东南州科技计划项目[黔东南科合J字2016(0025）号]
关键词
肺泡动脉氧分压差
急性呼吸窘迫综合征
急性生理与慢性健康评分系统Ⅱ
alveolar artery oxygen partial pressure difference
acute respiratory distress syndrome
acute physiology and chronic health evaluation systemⅡ
作者简介
王灵(1979-),副主任医师,学士,主要从事ARDS及休克相关研究;通信作者:王万灵,E-mail:463082910@qq.com。
