急性呼吸窘迫综合征死亡危险指标临界点的初步研究  

Indicator Point of the Risk Factor in Acute Respiratory Distress Syndrome

作　　者：卢树标[1] 蔡绍曦[2] 张超[3] 赵海金[2] 佟万成[2] 吴碧彤[4] 刘涓涓[5] 叶文慧[6] 陈晓云[7] 

机构地区：[1]广东省佛山市顺德区第一人民医院呼吸内科,528300 [2]南方医科大学附属南方医院呼吸内科 [3]南方医科大学统计教研室 [4]广州市胸科医院呼吸内科 [5]惠州市中心人民医院呼吸内科 [6]南方医科大学附属珠江医院呼吸内科 [7]江门市新会区人民医院呼吸内科

出　　处：《中国全科医学》2010年第19期2099-2102,共4页Chinese General Practice

摘　　要：目的探讨影响急性呼吸窘迫综合征(ARDS)患者预后的因素,并初步建立临床评估方法。方法选择1999年6月—2008年10月154例于南方医科大学附属南方医院、南方医科大学附属顺德区第一人民医院等6所医院明确诊断为ARDS患者的临床资料,选取确诊ARDS24h内的年龄、性别及血气分析等指标,根据其预后是否院内死亡对各项指标进行单因素检验及Logistic回归分析,筛选与ARDS死亡关系密切的因素,然后用受试者工作曲线确定其最佳临界点。结果单因素分析中,死亡组(102例)患者年龄、氧合指数、肺野数目、pH值、舒张压、血糖水平、二氧化碳分压、肺泡-动脉氧分压差与生存组(52例)比较差异均有统计学意义(P<0.05)。Logistic回归分析显示年龄、pH值、氧合指数、肺野数目等4个变量与ARDS患者预后有关(P<0.05)。以年龄、pH值、氧合指数、肺野数目推测ARDS死亡的受试者工作曲线下面积分别为0.808、0.736、0.850、0.811(P<0.05)。年龄的最佳临界点为43.5岁,诊断ARDS死亡的敏感度为74.5%,特异度为76.9%;pH值最佳临界点为7.37,敏感度为65.4%,特异度为67.6%;氧合指数的最佳临界点为102mmHg,诊断ARDS死亡的敏感度为63.7%,特异度为92.3%;肺野数目的最佳临界点为3个,诊断ARDS死亡的敏感度为57.8%,特异度为92.3%。结论 ARDS患者年龄>43.5岁、肺野数目>3个、氧合指数<102mmHg及pH值<7.37时提示预后不良。Objective To investigate the prognostic factors for patients with acute respiratory distress syndrome （ARDS） and primarily set up clinical assessment methods. Methods Retrospective study was performed among 154 patients with ARDS from June 1999 to October 2008 in 6 hospitals. The univariate test and multiple logistic regression method were taken, according to whether the prognosis is death in hospital stay, to analyze indicators of age, gender, and blood gas analysis within 24 hours of diagnosed ARDS. Then the factors closely related with the death were screened, and the optimal operating point was determined with receiver operator characteristic curve （ ROC ）. Results One - way ANVOA analysis revealed significant differences about the age, oxygenation index, sum of lung field, pH, diastolic blood pressure, blood glucose, PaCO2 , and P （ A - aO2 ） between the death group （ n = 102 ） and survival group （ n = 52 ） （ P 〈 0.05 ）. Multiple logistic regression showed that age, pH, oxygenation index, and sum of lung field were associated with the prognosis of ARDS patients （P 〈 0.05）, The results of ROC for died ARDS patients based on age, pH, oxygenation index, and sum of lung field were 0. 808, 0. 736, 0. 850, and 0. 811 respectively （ P 〈 0. 05 ）. The optimal operating point of age was 43.5, whose sensitivity and specificity for ARDS death ,were 74.5% and 76.9%. The optimal operating point of pH was 7.37, whose sensitivity and specificity were 65.4% and 67.6%. The optimal operating point of oxygenation index was 102 mm Hg, whose sensitivity and specificity were 63.7% and 92. 3%. The optimal operating point of sum of lung field was 3, whose sensitivity and specificity were 57. 8% and 92. 3%. Conchlsion The poor prognosis should be suspected when the ARDS patients age is 〉 43.5 years old, the number of lung field 〉 3, the oxygenation index 〈 102 mm Hg, and the pH value 〈7.37.

关 键 词：急性呼吸窘迫综合征 危险指标 临界点 

分 类 号：R563.8[医药卫生—呼吸系统]