红细胞分布宽度对重症肺炎预后评估的临床价值  

Clinical significance of red blood cell distribution width in predicting mortality in patients with severe pneumonia

作　　者：裴学勇[1] 马耀[1] 任节[1] 汪小玲[1] PEI Xue-yong;MA Yao;REN Jie;WANG Xiao-ling(Department of Critical Care Medicine,Maanshan People＇s Hospital,Maanshan 243000,Chin)

机构地区：[1]马鞍山市人民医院,马鞍山243000

出　　处：《内科急危重症杂志》2018年第3期226-229,共4页Journal of Critical Care In Internal Medicine

摘　　要：目的:探讨红细胞分布宽度(RDW)对重症肺炎患者预后的评估价值。方法:回顾性分析154例重症肺炎患者的临床资料。根据预后分为死亡组与存活组,比较2组临床资料。根据出院时RDW是否高于入院,分成RDW非升高组和RDW升高组,比较2组的临床资料;运用Kaplan-Meier生存曲线分析RDW升高组和RDW非升高组90 d累积生存率;应用COX回归分析重症肺炎患者死亡的危险因素。结果:死亡组患者RDW、RDW、血乳酸、APACHEⅡ评分均高于存活组(均P<0.05),血红蛋白(Hb)、氧合指数低于存活组(均P<0.05);RDW升高组的APACHEⅡ评分、入院RDW、乳酸显著高于RDW非升高组,氧合指数低于RDW非升高组(均P<0.05)。Kaplan-Meier生存曲线显示RDW升高组90d病死率高于RDW非升高组(χ~2=15.89,P<0.01)。COX回归分析显示RDW升高、氧合指数及APACHEⅡ评分是重症肺炎死亡的独立危险因素。结论:RDW的升高能较好显示重症肺炎的严重程度;尤其是RDW的动态上升可作为重症肺炎不良结局的预测指标,对重症肺炎的预后有重要的预测价值。Objective： To investigate the prognostic value of red cell distribution width（ RDW） in patients with severe pneumonia. Methods： The clinical data of 154 patients with severe pneumonia admitted to the Department of Critical Care Medicine and Department of Respiratory Diseases in our hospital from January 2012 to September 2017 were retrospectively analyzed. The general clinical data were collected,which included routine blood test,albumin and chronic health evaluationⅡ Acute Physiology（ APACHEⅡ） score within 24 h,the hospital stay,hospitalization time of mechanical ventilation,blood gas analysis,PCT,the last routine blood test and 90-day mortality rate. According to prognosis,the patients were divided into death group and survival group. The clinical data of the two groups were compared. Patients were divided into two groups according to whether the RDW at discharg was higher than that at admission. The 90-day birth rate was compared by KaplanMeier survival curves. The COX regression analysis was used to find risk factors for death in patients with severe pneumonia.Results： The scores of fist RDW and last RDW,lactic acid and APACHEⅡ score in the death group were significantly higher than those in the survival group（ P〈0. 05）,and the hemoglobin（ Hb） and oxygenation indexes in the death group were lower than those in the survival group（ P〈0. 05）. The scores of APACHEⅡ,RDW and lactic acid in RDW elevated group were significantly higher than those in RDW non-elevated group,and the oxygenation index in RDW elevated group was lower than that in RDW non-elevated group（ P〈0. 05）. The Kaplan-Meier survival curve showed that the 90-day mortality rate in the RDW elevated group was higher than that in the RDW non-elevated group（ χ^2= 15. 89,P〈0. 01）. Multivariate COX regression analysis revealed that elevated RDW,oxygenation index and APACHEⅡ score were independent risk factors of death for severe pneumonia. Conclusion： The elevated RDW is a good indicator of the severity

关 键 词：重症肺炎 红细胞分布宽度 乳酸 病死率 

分 类 号：R563.1[医药卫生—呼吸系统]