血管外肺水判断危重患者预后的系统评价  

Prognostic value of extravascular lung water in critically ill patients： A systematic review of the literature

作　　者：石远峰[1] 谢永鹏[1] 李吉光[1] 刘素霞[1] 王言理[1] 刘克喜[1] 顾彩虹[1] 陈晓兵[1] 

机构地区：[1]江苏省连云港市第一人民医院重症医学科,江苏222002

出　　处：《中国急救复苏与灾害医学杂志》2015年第12期1134-1138,共5页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的系统评价血管外肺水（extravascular lung water，EVLW）判断危重患者预后的诊断准确性。方法检索Pubmed、Embase、中国学术期刊全文数据库（CNKI）、重庆维普中文科技期刊全文数据库（VIP）和万方数据库等数据库，筛选血管外肺水与危重患者预后的相关文献，使用QUIPS（QualityInPrognosisStudies）质量评价量表评价纳入文献的偏移风险，2名研究人员独立筛选、评价文献和收集数据，采用Revman5．3和Metadiscl．4进行统计学分析。结果共纳入12篇符合人选标准文献，纳入研究样本量均不大，共572例研究对象，分布在我国8个省份的ICU病房，数据合并结果提示死亡组血管外肺水明显高于存活组（MD=5．54，95％CI：4．75～6．32），EVLW判断危重患者预后诊断准确性合并数据：敏感性84％（79％～88％）；特异性73％（68％～78％）；阳性似然比2．92（2．24—3．80）；阴性似然比0．24（0．18～0．32）；sROC曲线下面积0．8749。结论EVLW是危重患者预后不佳的危险因素，可以较好的判断危重患者的预后。Objectives To systematically review the literature evaluating the prognostic value of extravascular lung water （EVLW）. Methods Two independent reviewers performed systematic searches of Pubmed, Embase, CNKI, WanFang Data and VIP to identify potentially relevant studies investigating the prognostic value of EVLW in critically ill patients. A pooled,analysis was conducted by adopting Revman 5.3 and Metadiscl.4. Results A total of 572 cases which were collected from 8 provinces were consisted of the 12 papers. Overall, the EVLWI was significantly higher in non-survival group than the survival group with a mean difference of 5.54mL/kg （95% confidence interval, 4.75 to 6.32）. The pooled statistics of diagnostic accuracy together with relevant 95% confidence interval reflected as follows： sensitivity, 84% （79%--88%）; specificity, 73% （68%--78%）; positive LR 2.92 （2.24--3.80）; negative LR 0.24 （0.18- 0.32）; sROC 0.8749. Conclusion The EVLW may serve as valid indicator of mortality in critically ill patients.

关 键 词：血管外肺水 预后 死亡率 脓毒症 急性呼吸窘迫综合征 

分 类 号：R541[医药卫生—心血管疾病]