中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2014年
3期
257-260
,共4页
乔莉%张劲松%张华忠%马元%苏成磊
喬莉%張勁鬆%張華忠%馬元%囌成磊
교리%장경송%장화충%마원%소성뢰
氧合指数%APACHEⅡ评分%SOFA评分%急性呼吸窘迫综合征%病死率
氧閤指數%APACHEⅡ評分%SOFA評分%急性呼吸窘迫綜閤徵%病死率
양합지수%APACHEⅡ평분%SOFA평분%급성호흡군박종합정%병사솔
Oxygenation index%APACHE Ⅱ score%Sequential Organ Failure Assessment (SOFA)%Acute respiratory distress syndrome%Mortality
目的 探讨氧合指数对有创机械通气后急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者预后的评估价值.方法 回顾性分析2008年9月至2013年9月南京医科大学第一附属医院ICU内符合ARDS柏林标准诊断的患者病例资料,包括有创机械通气d0、d1、d3的氧合指数(PaO2/FiO2),比较不同时间点氧合指数与预后的关系.结果 236例患者符合ARDS柏林标准的患者入ICU时的APACHEⅡ评分(19.1±3.0),SOFA评分(10.8±2.5).有创机械通气治疗开始(d0) PaO2/FiO2平均值(150.3 ±62.6) mmHg(1 mmHg=0.133 kPa),轻、中、重度ARDS分组,PaO2/FiO2数值分别为(80.1±8.1)、(162.3 ±19.9)、(261.6±22.3)mmHg,差异具有统计学意义(P<0.05).死亡组前3d的氧合指数差异无统计学意义;存活组中d3的氧合指数高于d0,差异具有统计学意义(P<0.05).入院初APACHEⅡ评分、SOFA评分、d3的氧合指数,对预后影响有统计学意义(P<0.05).d3的氧合指数≤180 mmHg作为分界点,ROC曲线下面积为0.749,敏感性61.7%,特异性93.2%,与0.5比较差异具有统计学意义(P<0.05).结论 ARDS患者动态监测氧合指数,对患者早期病情评估有价值;第3天的氧合指数≤180mmHg,往往提示临床预后差.
目的 探討氧閤指數對有創機械通氣後急性呼吸窘迫綜閤徵(acute respiratory distress syndrome,ARDS)患者預後的評估價值.方法 迴顧性分析2008年9月至2013年9月南京醫科大學第一附屬醫院ICU內符閤ARDS柏林標準診斷的患者病例資料,包括有創機械通氣d0、d1、d3的氧閤指數(PaO2/FiO2),比較不同時間點氧閤指數與預後的關繫.結果 236例患者符閤ARDS柏林標準的患者入ICU時的APACHEⅡ評分(19.1±3.0),SOFA評分(10.8±2.5).有創機械通氣治療開始(d0) PaO2/FiO2平均值(150.3 ±62.6) mmHg(1 mmHg=0.133 kPa),輕、中、重度ARDS分組,PaO2/FiO2數值分彆為(80.1±8.1)、(162.3 ±19.9)、(261.6±22.3)mmHg,差異具有統計學意義(P<0.05).死亡組前3d的氧閤指數差異無統計學意義;存活組中d3的氧閤指數高于d0,差異具有統計學意義(P<0.05).入院初APACHEⅡ評分、SOFA評分、d3的氧閤指數,對預後影響有統計學意義(P<0.05).d3的氧閤指數≤180 mmHg作為分界點,ROC麯線下麵積為0.749,敏感性61.7%,特異性93.2%,與0.5比較差異具有統計學意義(P<0.05).結論 ARDS患者動態鑑測氧閤指數,對患者早期病情評估有價值;第3天的氧閤指數≤180mmHg,往往提示臨床預後差.
목적 탐토양합지수대유창궤계통기후급성호흡군박종합정(acute respiratory distress syndrome,ARDS)환자예후적평고개치.방법 회고성분석2008년9월지2013년9월남경의과대학제일부속의원ICU내부합ARDS백림표준진단적환자병례자료,포괄유창궤계통기d0、d1、d3적양합지수(PaO2/FiO2),비교불동시간점양합지수여예후적관계.결과 236례환자부합ARDS백림표준적환자입ICU시적APACHEⅡ평분(19.1±3.0),SOFA평분(10.8±2.5).유창궤계통기치료개시(d0) PaO2/FiO2평균치(150.3 ±62.6) mmHg(1 mmHg=0.133 kPa),경、중、중도ARDS분조,PaO2/FiO2수치분별위(80.1±8.1)、(162.3 ±19.9)、(261.6±22.3)mmHg,차이구유통계학의의(P<0.05).사망조전3d적양합지수차이무통계학의의;존활조중d3적양합지수고우d0,차이구유통계학의의(P<0.05).입원초APACHEⅡ평분、SOFA평분、d3적양합지수,대예후영향유통계학의의(P<0.05).d3적양합지수≤180 mmHg작위분계점,ROC곡선하면적위0.749,민감성61.7%,특이성93.2%,여0.5비교차이구유통계학의의(P<0.05).결론 ARDS환자동태감측양합지수,대환자조기병정평고유개치;제3천적양합지수≤180mmHg,왕왕제시림상예후차.
Objective To determine the value of oxygenation index in assessing the outcome of mechanical ventilated patients with acute respiratory distress syndrome (ARDS).Methods From September 2008 to September 2013,patients meeting the Berlin definition of ARDS were evaluated in this retrospective study.Data included oxygenation index (PaO2/FiO2) on day before,and day 1 and day 3 after mechanical ventilation.The levels of PaO/FiO2 on day before and day 1 after mechanical ventilation were compared between 28-day survivors and non-survivors.Results There were 236 patients meeting the criteria of the Berlin Definition for diagnosis and treated with mechanical ventilation.The mean score of APACHIE Ⅱ and sequential organ failure assessment (SOFA) at the beginning were (19.1 ± 3.0) and (10.8 ±2.5),respectively,while oxygenation index on day before mechanical ventilation was (150.3 ± 62.6) mmHg.According to the hypoxemia grade,patients were divided into mild (n =36),moderate (n =122) and severe (n =78) ARDS,and their levels of PaO2/FiO2 were (80.1 ± 8.1),(162.3 ± 19.9) and (261.6 ± 22.3) mmHg,respectively.There were 92 non-survivors and 144 survivors.No obvious difference in oxygenation index of non-survivors among on day before、and day 1 and day 3 after mechanical ventilation.There was statistically significant difference in oxygenation index between on day before and day 1 after mechanical ventilation in survivors (P < 0.05).Compared with the survivors,the score of APACHE Ⅱ,SOFA,and oxygenation index on day 3 were associated with increased mortality in the non-survivors,respectively (P < 0.05).In respect to the mortality,the cut-off point of score of oxygenation index set at < 180 mmHg on Day 3,an area under the receiver operating curve (AUC) was 0.749 with statistically significance (P < 0.05),leading to sensitivity 61.7% and specificity 93.2%.The relationship between prognosis and antibiotic resistance did not have statistically significance.Conclusions Data of oxygenation index on early phage of ARDS may be valuable to predict the outcome.A strong predictor of adverse outcome in such conditions was the score of oxygenation index on Day 3 ≤ 180 mmHg.