早期SOFA评分及EVLWi变化对ARDS患者预后评估价值  

Prognosis evaluation value of change of early SOFA score and EVLWi in patients with ARDS

作　　者：刘怡[1] 杨甦庆[2] 

机构地区：[1]重庆医科大学附属第一医院中心ICU,重庆400010 [2]重庆医疗器械质量检验中心质保科,重庆401147

出　　处：《现代医药卫生》2016年第3期343-345,共3页Journal of Modern Medicine & Health

摘　　要：目的探讨通过早期的序贯器官衰竭估计评分（SOFA评分）及血管外肺水指数（EVLWi）变化判断急性呼吸窘迫综合征（ARDS）患者的预后。方法回顾性分析该院重症监护病房（ICU）自2012年1月至2015年8月共收治的78例ARDS患者（年龄均大于16岁）的临床资料。经脉搏指示心排出量（PICCO）监测使用热稀释法获得EVLWi。48 h内测定SOFA评分和EVLWi的初始值（第0天）、平均值、最高值和ΔEVLWi（第2天减去第0天的差值）,以及其他与评估预后密切相关的指标,包括年龄、动脉血气分析、血清肌酐、液体平衡情况、使用利尿剂及血管活性药物情况等。结果共评估了78例ARDS患者,结合SOFA评分,得出28 d全因死亡率31%。在死亡病例组患者EVLWi的初始值、平均值及最高值较存活组无显著差异,但死亡患者组ΔEVLWi有显著升高（3.1 m L/kg vs.0.3 m L/kg,P=0.006）。经COX比例风险模式分析,患者年龄、ΔSOFA、ΔEVLWi是患者预后的独立预测因子。ΔEVLWi〉2.9的患者28 d存活率显著高于ΔEVLWi≤2.9的患者（χ~2=7.06,P=0.008）。结论 ARDS患者最初48 h内EVLWi及SOFA评分明显下降的患者与28 d预后密切相关。因此ΔSOFA、ΔEVLWi有助于临床早期甄别预后差的患者。Objective To investigate to use the sequential organ failure assessment（SOFA） score and external venous lung water index （EVLWi） changes to evaluate the prognosis in the patients with acute respiratory distress syndrome （ARDS）. Methods The clinical data in 78 patients （age 〉16 years old） with ARDS in ICU of our hospital from January 2012 to August 2015 were retrospectively analyzed. The pulse induced contour cardiac output （PICCO） monitoring used the thermodilution method for ob- taining EVLWi. The SOFA scoer, initial value （0 d）, mean value, highest value and AEVLWi （difference value of 2 d minus 0 d） of EVLWi and other prognosis evaluation related factors including age, arterial blood gas analysis,serum creatinine,fluid bal- ance, use of vasopressors and diuretic use, etc. were detected within 48 h. Results Totally 78 ARDS patients were evaluated, by combining with the SOFA score,the all-cause 28 d mortality was 31%. There were no significant differences in the initial,mean and maximum EVLWi values between the death group and the survival group ,but AEVLWi in the death group was obviously increased （3.1 mL/kg vs. 0.3 mL/kg, P=0.006）. The age, ASOFA and AEVLWi were the independent prognostic factors suggested by the COX proportional hazards regression analysis. The patients with AEVLWi〉2.9 had significantly higher 28 d survival rate than the patients with △EVLWi ≤ 2.9 （X2=7.06,P=0.008）. Conclusion The ARDS patients with decreased EVLWi and SOFA score in initial 48 h maybe associated with the 28 d prognosis. Thus ASOFA and AEVLWi is conducive to early clinical screening of the patients with poor prognosis.

关 键 词：呼吸窘迫综合征 成人 心排血量 血液稀释 心舒期 血管外肺水 肺/损伤 毛细血管通透性 肺泡/病理学 

分 类 号：R59[医药卫生—内科学]