慢性阻塞性肺疾病和支气管哮喘预后评分在慢性阻塞性肺疾病急性加重期并机械通气患者远期预后评估中的应用价值  

Value of the COPD and Asthma Prognostic Score in Long-term Prognosis Evaluation in AECOPD Patients with Mechanical Ventilation

作　　者：汪正光[1] 张牧城[1] 方向群[1] 程金霞[1] 谢立德[1] 

机构地区：[1]皖南医学院附属黄山市人民医院重症医学科,安徽省黄山市245000

出　　处：《中国全科医学》2014年第2期148-150,共3页Chinese General Practice

摘　　要：目的探讨慢性阻塞性肺疾病和支气管哮喘预后评分(CAP评分)对慢性阻塞性肺疾病急性加重期(AECOPD)并机械通气患者远期预后的评估价值。方法选择2009年8月—2012年9月在本院重症医学科(ICU)住院的AECOPD并机械通气患者64例,进行CAP评分。以患者入住ICU作为观察起点,以患者死亡或入住ICU 180 d为观察终点,计算实际病死率及生存时间。结果最终共纳入55例患者,其中死亡30例(死亡组),存活25例(存活组),实际病死率为55%,与CAP评分预测死亡风险(60%)比较,差异无统计学意义(P=0.244)。死亡组CAP评分为(129±30)分,存活组为(108±19)分,死亡组CAP评分大于存活组(t=-2.977,P=0.004)。Spearman相关分析结果显示,CAP评分与实际病死率呈正相关(r=0.893,P=0.007)。绘制ROC曲线发现,CAP评分预测AECOPD并机械通气患者死亡的曲线下面积为0.734〔95%CI(0.600,0.868),P=0.003〕,当取CAP评分为110分时Youden指数最大,为0.4。绘制Kaplan-Meier曲线发现,本组患者平均生存期为102 d〔95%CI(82,122)〕,中位生存期为114 d〔95%CI(31,197)〕。结论 CAP评分能够较为准确地评估AECOPD并机械通气患者病情严重程度及预测患者远期预后。Objective To explore the value of the COPD and Asthma Prognostic Score （ CAP score） in the long - term prognosis evaluation of acute exacerbation of chronic obstructive pulmonary dissease （AECOPD） patients with mechanical ventilation （MV）. Methods A CAP score was performed in 64 AECOPD patients with MV hospitalized in ICU of this hospital from August 2009 to September 2012. With ICU check - in as starting point, patients＇death or 180 - day ICU stay as ending point, the actual fatality rate and survival time were calculated. Results A total of 55 patients were enrolled at last, in whom 30 died, 25 survived, the actual fatality rate was 55% , which was not significantly different from the predicted death risk of CAP score （60%） （P =0. 244）. The CAP score was higher in death group （ 129 ±30） than in survival group （ 108 ±19） （t = - 2. 977, P = 0. 004 ）. By Spearman correlation analysis, CAP score was positively correlated with actual fatality rate （ r = 0. 893, P =0. 007）. By ROC curve, the area under curve of CAP score predicting AECOPD with MV patients＇death was 0. 734 [95%CI （0. 600, 0. 868）, P=0. 003], Youden index （0. 4） was the biggest when CAP score was 110. Kaplan -Meier curve showed that the mean survival time was 102 d （95%CI （82, 122）], median survival time was 114 d [95%CI （31, 197 ） ]. Conclusion CAP score can evaluate the severity of AECOPD patients with MV and predict their long - term prognoses.

关 键 词：肺疾病 慢性阻塞性 预后 通气机 机械 慢性阻塞性肺疾病和支气管哮喘预后评分 

分 类 号：R454.4[医药卫生—治疗学] R563[医药卫生—临床医学]