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重症急性呼吸窘迫综合征临床转归的预测因素分析
作者:仇晟 王美菊 焦玉丁 刘双林 李琦 
单位:400037  重庆  陆军军医大学附属新桥医院、全军呼吸内科研究所(仇晟、王美菊、焦玉丁、刘双林、李琦) 266000  山东青岛  海军海上防险救生支队(仇晟) 
关键词:急性呼吸窘迫综合征 预后 APACHE Ⅱ评分 氧合指数 
分类号:R563.8
出版年,卷(期):页码:2018,43(2):166-171
摘要:

[摘要]  目的  分析重症急性呼吸窘迫综合征(ARDS)患者的临床转归,并筛选与其死亡风险相关的预测指标。方法  收集陆军军医大学新桥医院重症监护病房20122月-20174月收治的重症ARDS患者的临床资料,计算急性病理生理学和慢性健康评价(APACHE)评分、肺外脏器衰竭数目以及确诊后患者28d死亡发生率。动态记录比较患者各基线指标7d内的变化,采用logistic回归筛选危险因素并构造风险预测模型,采用受试者工作特征曲线(ROC)对模型的预测效率进行分析。结果  研究收集ARDS病例237例,最终纳入符合标准者71例,患者28d死亡发生率为57.7%(41/71)。单因素logistic回归分析表明,基线APACHE评分,治疗7d后肺外器官功能障碍数目,以及APACHE评分、pH值、CO2分压和氧合指数的7d变化率与患者死亡风险明显相关,其中APACHE评分≥18分的患者死亡风险是<18分患者的3.23倍。多因素logistic回归分析显示,肺外脏器衰竭数目和APACHE评分7d变化率是入院后28d死亡的独立危险因素。将两者作为协变量构造重症ARDS患者28d死亡发生率的预测模型,其灵敏度、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为93.9%91.7%93.3%91.7%结论 治疗7d后肺外脏器衰竭数目和APACHE评分7d变化率是ARDS患者死亡的独立危险因素,对患者28d病情转归有较好的预测作用,可作为评价重症ARDS患者预后的指标。

[Abstract]  Objective  To determine the prognostic indicators of severe acute respiratory distress syndrome (ARDS) by comprehensive analysis. Methods  The clinical data of 71 patients with ARDS admitted from Feb. 2012 to Apr. 2017 were retrospectively collected and analyzed. The acute pathophysiology and chronic health evaluation (APACHE ) score, occurrence of extrapulmonary organ dysfunction and mortality within 28d after final diagnosis were calculated. The risk factors were screened using the logistic regression analysis to construct the risk prediction model by dynamic recording and comparing the variation of each baseline index within 7 days, and ROC curve was used to evaluate the prediction efficiency of the model. Results  Of the 71 cases analyzed, the overall mortality within 28d after final diagnosis was 57.7%(41/71). Single factor logistic regression analysis showed that the APACHE score, the occurrence of extrapulmonary organ dysfunction, the changing rate within 7 days of APACHE score, pH, CO2 partial pressure and oxygenation index were significantly related to mortality. Multiple logistic regression showed that the occurrence of extrapulmonary organ dysfunction and the changing rate within 7 days of APACHE score were the independent risk factors for the death of patients 28 days after admission. The prediction model of 28d mortality in ARDS patients was constructed using the single factor- and multiple logistic regression as covariant, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the model were 93.9%, 91.7%, 93.3% and 91.7%, respectively. Conclusions Occurrence of extrapulmonary organ dysfunction and changing rate within 7 days of APACHE score can be used as an indicator to evaluate the prognosis of patients with severe ARDS.

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