肺损伤预测评分在ALI/ARDS早期诊断中的应用  

Evaluation of Lung Injury Prediction Score in Early Identification of Patients at Risk of ALI/ARDS

作　　者：夏炎火[1] 童秋玲[2] 林锡芳[1] 王丹[1] 朱海萍[1] 戴震宇[1] 

机构地区：[1]温州医学院附属第一医院ICU [2]温州医学院附属第一医院神经内科

出　　处：《医学研究杂志》2013年第2期120-123,共4页Journal of Medical Research

基　　金：温州市科技局基金资助项目(Y20110167)

摘　　要：目的评估肺损伤预测评分(LIPS)在早期预测急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)中的价值和可行性。方法对43例ALI/ARDS患者和32例非ALI/ARDS患者分别进行LIPS、肺损伤评分(LIS)和急性生理学及慢性健康状况(APACHE)Ⅱ评分,计算两组病死率,并对结果进行比较和相关性分析,利用受试者工作特征(ROC)曲线评价LIPS和LIS的诊断分辨度。结果与非ALI/ARDS组相比,ALI/ARDS组的ICU平均住院时间、LIPS和LIS较高,而PaO2/FiO2相对较低,且病死率高达34.88%。LIPS与LIS呈明显正相关(r=0.669,P<0.001),但LIPS、LIS与APACHEⅡ评分间的相关性不强(r分别为0.460和0.342,P<0.05)。LIPS评分对预测ALI/ARDS有意义[曲线下面积(AUC)=0.832,95%CI:0.728～0.908,P<0.001],当LIPS>7分时,预测ALI/ARDS的敏感度为83.72%,特异性为78.12%。LIS评分对预测ALI/ARDS也有意义(AUC=0.802,95%CI:0.693～0.885,P<0.001),LIS>0.67分时,预测ALI/ARDS的敏感度、特异性分别为81.40%和77.80%。结论 LIPS对预测ALI/ARDS的准确性较好,且与LIS系统具有较好的相关性,早期即可获得,临床操作性较强,该评分系统为早期预测ALI/ARDS提供了可能。Objective To evaluate the value and feasibility of lung injury prediction score （LIPS） in early identification of ALI/ ARDS. Methods The clinical data of 43 ALI/ARDS patients and 32 non - ALl / ARDS patients was collected and evaluated with LIPS, lung injury score（LIS） and APACHE Ⅱ score system. Mortality of two groups and correlation analysis were evaluated. The forecast value of LIPS and LIS in diagnosis of ALI/ARDS was analyzed by receiver operator characteristic （ROC） curve. Results Compared with non - ALI/ARDS group, the average hospitalization days in ICU, LIPS and LIS of ALI/ ARDS group were significantly higher,but the PaO2/ FiO~ was lower. Furthermore, the mortality of ALI/ARDS group was very high （34.88%）. The LIPS of patients had positive correlation with the LIS （ r = 0. 669,P 〈 0. 001 ）, but LIPS and LIS of patients had no obvious correlation with APACHE Ⅱ （ r = 0. 460 and 0. 342,P 〈 0,005）. A receiver operator characteristic curve analysis showed that LIPS predicted ALI/ARDS （ the area under the curve （AUC） = 0. 832, 95% CI：0. 728 - 0. 908,P 〈 0. 001 ） and LIS predicted ALI/ARDS （ AUC = 0. 802,95% C1：0. 693 - 0. 885, P 〈 0. 001 ）. The sensitivity and specificity of LIPS were respectively 83.72% and 78.12% when LIPS 〉 7 points; while the sensitivity and specificity ofLIS was 81.40% and 77.80% when LIS 〉 0.67 points. Conclusion The accuracy of LIPS system to predict ALI/ARDS was better. LIPS system has a positive correlation with the LIS system, and the score parameters are easy to be obtained, so it would be possible to ap- ply LIPS system for early identification of patients at risk of ALI/ARDS.

关 键 词：ALI ARDS LIPS LIS APACHEⅡ 诊断 

分 类 号：R641.06[医药卫生—外科学]