中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2014年
3期
197-201
,共5页
臧芝栋%许红阳%董亮%高飞%严洁
臧芝棟%許紅暘%董亮%高飛%嚴潔
장지동%허홍양%동량%고비%엄길
代谢清除率%体外膜氧合作用%呼吸功能不全%预后
代謝清除率%體外膜氧閤作用%呼吸功能不全%預後
대사청제솔%체외막양합작용%호흡공능불전%예후
Metabolic clearance rate%Extracorporeal membrane oxygenation%Respiratory insufficiency%Prognosis
目的 探讨早期乳酸清除率对体外膜氧合(ECMO)治疗后的重症急性呼吸衰竭患者预后的评估作用.方法 选取2007年1月至2013年1月南京医科大学附属无锡市人民医院ICU收治的因重症急性呼吸衰竭而接受静脉-静脉(v-v) ECMO治疗的患者共43例.分别在治疗前Oh和治疗后6h测定动脉血乳酸,计算早期(6 h)乳酸清除率,并在治疗当天进行APACHEⅡ评分.以治疗后90 d为研究终点,将患者分为存活组(24例)和病死组(19例),比较两组患者治疗前动脉血乳酸值、早期乳酸清除率及APACHEⅡ评分.采用受试者工作特征(ROC)曲线分析0h动脉血乳酸、早期乳酸清除率及APACHEⅡ评分对患者预后的评估价值.运用Kaplan-Meier法绘制患者的生存曲线,Log-rank法分析患者生存情况.多因素Logistic回归分析影响患者预后的危险因素.结果 (1)存活组0h动脉血乳酸[(3.8±2.1)mmol/L]和APACHEⅡ评分(18±7)低于病死组[分别为(5.9±2.3) mmol/L和(25±7),t值分别为7.924和8.446,均P＜0.05],但早期乳酸清除率高于病死组[分别为(35.7±20.4)％和(10.7±18.2)％,t=8.607,P＜0.05].(2)0h动脉血乳酸、早期乳酸清除率及APACHEⅡ评分预测患者90 d死亡的ROC曲线下面积分别为0.699±0.083(95％ CI为0.567～0.892,P ＜0.05)、0.871 ±0.119(95％ CI为0.724～0.980,P ＜0.05)和0.836±0.063(95％ CI为0.713 ～0.958,P＜0.05).以早期乳酸清除率≥17.5％作为评估预后的最佳界值点,敏感度和特异度分别为87.5％和84.2％.(3)Kaplan-Meier生存曲线分析结果显示,高乳酸清除率患者(≥17.5％)和低乳酸清除率患者(＜ 17.5％)90 d生存率分别为78.3％和30％(x2=10.103,P＜0.05).(4)多因素Logistic回归分析显示0h血乳酸(OR=1.318,95％ CI为1.159 ～6.882,P＜0.05)、6h乳酸清除率(OR=6.921,95％ CI为4.469 ～ 15.036,P＜0.05)和APACHEⅡ评分(OR=4.417,95％ CI为3.058 ～ 10.356,P＜0.05)均是患者死亡的独立危险因素.结论 早期乳酸清除率可作为判断ECMO治疗后重症急性呼吸衰竭患者预后的重要指标.
目的 探討早期乳痠清除率對體外膜氧閤(ECMO)治療後的重癥急性呼吸衰竭患者預後的評估作用.方法 選取2007年1月至2013年1月南京醫科大學附屬無錫市人民醫院ICU收治的因重癥急性呼吸衰竭而接受靜脈-靜脈(v-v) ECMO治療的患者共43例.分彆在治療前Oh和治療後6h測定動脈血乳痠,計算早期(6 h)乳痠清除率,併在治療噹天進行APACHEⅡ評分.以治療後90 d為研究終點,將患者分為存活組(24例)和病死組(19例),比較兩組患者治療前動脈血乳痠值、早期乳痠清除率及APACHEⅡ評分.採用受試者工作特徵(ROC)麯線分析0h動脈血乳痠、早期乳痠清除率及APACHEⅡ評分對患者預後的評估價值.運用Kaplan-Meier法繪製患者的生存麯線,Log-rank法分析患者生存情況.多因素Logistic迴歸分析影響患者預後的危險因素.結果 (1)存活組0h動脈血乳痠[(3.8±2.1)mmol/L]和APACHEⅡ評分(18±7)低于病死組[分彆為(5.9±2.3) mmol/L和(25±7),t值分彆為7.924和8.446,均P＜0.05],但早期乳痠清除率高于病死組[分彆為(35.7±20.4)％和(10.7±18.2)％,t=8.607,P＜0.05].(2)0h動脈血乳痠、早期乳痠清除率及APACHEⅡ評分預測患者90 d死亡的ROC麯線下麵積分彆為0.699±0.083(95％ CI為0.567～0.892,P ＜0.05)、0.871 ±0.119(95％ CI為0.724～0.980,P ＜0.05)和0.836±0.063(95％ CI為0.713 ～0.958,P＜0.05).以早期乳痠清除率≥17.5％作為評估預後的最佳界值點,敏感度和特異度分彆為87.5％和84.2％.(3)Kaplan-Meier生存麯線分析結果顯示,高乳痠清除率患者(≥17.5％)和低乳痠清除率患者(＜ 17.5％)90 d生存率分彆為78.3％和30％(x2=10.103,P＜0.05).(4)多因素Logistic迴歸分析顯示0h血乳痠(OR=1.318,95％ CI為1.159 ～6.882,P＜0.05)、6h乳痠清除率(OR=6.921,95％ CI為4.469 ～ 15.036,P＜0.05)和APACHEⅡ評分(OR=4.417,95％ CI為3.058 ～ 10.356,P＜0.05)均是患者死亡的獨立危險因素.結論 早期乳痠清除率可作為判斷ECMO治療後重癥急性呼吸衰竭患者預後的重要指標.
목적 탐토조기유산청제솔대체외막양합(ECMO)치료후적중증급성호흡쇠갈환자예후적평고작용.방법 선취2007년1월지2013년1월남경의과대학부속무석시인민의원ICU수치적인중증급성호흡쇠갈이접수정맥-정맥(v-v) ECMO치료적환자공43례.분별재치료전Oh화치료후6h측정동맥혈유산,계산조기(6 h)유산청제솔,병재치료당천진행APACHEⅡ평분.이치료후90 d위연구종점,장환자분위존활조(24례)화병사조(19례),비교량조환자치료전동맥혈유산치、조기유산청제솔급APACHEⅡ평분.채용수시자공작특정(ROC)곡선분석0h동맥혈유산、조기유산청제솔급APACHEⅡ평분대환자예후적평고개치.운용Kaplan-Meier법회제환자적생존곡선,Log-rank법분석환자생존정황.다인소Logistic회귀분석영향환자예후적위험인소.결과 (1)존활조0h동맥혈유산[(3.8±2.1)mmol/L]화APACHEⅡ평분(18±7)저우병사조[분별위(5.9±2.3) mmol/L화(25±7),t치분별위7.924화8.446,균P＜0.05],단조기유산청제솔고우병사조[분별위(35.7±20.4)％화(10.7±18.2)％,t=8.607,P＜0.05].(2)0h동맥혈유산、조기유산청제솔급APACHEⅡ평분예측환자90 d사망적ROC곡선하면적분별위0.699±0.083(95％ CI위0.567～0.892,P ＜0.05)、0.871 ±0.119(95％ CI위0.724～0.980,P ＜0.05)화0.836±0.063(95％ CI위0.713 ～0.958,P＜0.05).이조기유산청제솔≥17.5％작위평고예후적최가계치점,민감도화특이도분별위87.5％화84.2％.(3)Kaplan-Meier생존곡선분석결과현시,고유산청제솔환자(≥17.5％)화저유산청제솔환자(＜ 17.5％)90 d생존솔분별위78.3％화30％(x2=10.103,P＜0.05).(4)다인소Logistic회귀분석현시0h혈유산(OR=1.318,95％ CI위1.159 ～6.882,P＜0.05)、6h유산청제솔(OR=6.921,95％ CI위4.469 ～ 15.036,P＜0.05)화APACHEⅡ평분(OR=4.417,95％ CI위3.058 ～ 10.356,P＜0.05)균시환자사망적독립위험인소.결론 조기유산청제솔가작위판단ECMO치료후중증급성호흡쇠갈환자예후적중요지표.
Objective To investigate the prognostic significance of early lactate clearance rate for severe acute respiratory failure patients on extracorporeal membrane oxygenation(ECMO).Methods Fortythree patients with severe acute respiratory failure supported by venous-venous (r-y) ECMO were enrolled from January 2007 to January 2013.Arterial blood lactate at pre-ECMO support(0 h) and at post-ECMO 6 hours (6 h) were measured and then 6 h lactate clearance rate was calculated.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was evaluated on the first day of ECMO support.Survival at 90 d after admission was the study endpoint.Patients were divided into the survival group (n =24) and the death group (n =19).The 0 h blood lactate,6 h lactate clearance rate and APACHE Ⅱ score were compared between groups.The value of 0 h blood lactate,6 h lactate clearance rate and APACHE Ⅱ score for predicting death was evaluated by receiver operating characteristic (ROC) curves.The surviving curve was drawn using the Kaplan-Meier method,and the survival of the patients was analyzed by the Log-rank test.Factors influencing the prognosis were analyzed by the multiple logistic regression analysis.Results (1) The 0 h blood lactate and APACHE Ⅱ score were lower in survivors than in nonsurvivors [(3.8 ± 2.1) mmol/Lvs.(5.9 ±2.3)mmol/L,(18 ±7) vs.(25 ±7),t =7.924,8.446,respectively,both P＜0.05],while the 6 h lactate clearance rate was higher in survivors than in nonsurvivors [(35.7 ± 20.4) ％ vs.(10.7 ± 18.2)％,t =8.607,P ＜0.05].(2)The areas under the ROC curve of 0 h blood lactate,6 h lactate clearance rate and APACHE lⅡ score for predicting death were 0.699 ± 0.083 (95％ CI:0.567 ～ 0.892,P ＜0.05),0.871 ± 0.119 (95％ CI:0.724 ～ 0.980,P ＜ 0.05) and 0.836 ± 0.063 (95％ CI:0.713 ～0.958,P ＜0.05).The best cutoff point was 17.5％ for 6 h lactate clearance with a sensitivity of 87.5％ and specificity of 84.2％.(3) Kaplan-Meier survival analysis showed that 90 d survival rate of the high lactate clearance rate group and the low lactate clearance rate group were 78.3％ and 30％,with significant difference between the two groups (x2 =10.103,P ＜0.05).(4)Multivariate logistic regression analysis showed that 0 h blood lactate (OR =1.318,95％ CI:1.159 ～ 6.882,P ＜ 0.05),6 h lactate clearance rate (OR =6.921,95％ CI:4.469 ～ 15.036,P ＜ 0.05) and APACHE lⅡ score (OR =4.417,95％ CI:3.058～ 10.356,P ＜0.05) were independent risk factors associated with mortality of patients on ECMO.Conclusion Early lactate clearance rate could be used as an important variable for evaluating the prognosis of severe acute respiratory failure patients on ECMO.
