急性呼吸窘迫综合征患者APACHE Ⅱ评分和血浆vWF水平对预后评估的价值  

EVALUATION OF APACHE Ⅱ SCORE AND PLASMA VWF IN PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME AND ITS PROGNOSTIC SIGNIFICANCE

作　　者：张俊娜[1] 杨雪 冯倩[1] Zhang Junna;Yang Xue;Feng Qian(Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China)

机构地区：[1]重庆市中医院,400021

出　　处：《中国煤炭工业医学杂志》2018年第3期229-234,共6页Chinese Journal of Coal Industry Medicine

基　　金：四川省卫生厅科研课题(编号:110171)

摘　　要：目的探讨急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分和血浆血管性血友病因子(vWF)水平对急性呼吸窘迫综合征(ARDS)患者的肺损伤程度及预后评估的价值。方法选取我院2012年5月—2016年12月收治的96例ARDS患者作为研究对象,采用回顾性分析法分析所有患者的临床及随访资料。根据其资料结果记录所有ARDS患者的一般临床情况和APACHE Ⅱ评分、肺损伤评分以及vWF水平,并比较不同ARDS患者在上述资料间的差异。结果 (1)二组患者第2天APACHE Ⅱ评分和vWF水平均升高,但差异无统计学意义,但第3天其APACHE Ⅱ评分和vWF水平均较第1天明显升高,且死亡组患者第1天到第3天时的变化值显著大于存活组,比较差异均有统计学意义(P<0.05);(2)存活组第1天肺损伤评分较死亡组低,PaO_2/FiO_2水平较死亡组高,第3天存活组肺损伤评分有所下降,但是死亡组在此刻肺损伤评分上升,PaO_2/FiO_2水平仍较存活组低,比较差异均有统计学意义(P<0.05);(3)APACHE Ⅱ评分、vWF水平和肺损伤评分之间均有着密切联系,且均呈正相关关系(P<0.05);(4)经ROC分析可得,当APACHE Ⅱ评分截点值为28.6分时,对评估ARDS患者预后价值灵敏度和特异度最佳,分别为88.62%和82.34%,而当vWF水平在204.8%时,对评估ARDS患者预后价值灵敏度和特异度最佳,分别为83.64%和特异度80.02%。结论 APACHE Ⅱ评分和vWF水平和肺损伤评分之间均呈正相关关系,且对评估ARDS患者的预后情况均具有较好的灵敏度和特异度,可作为评估ARDS患者其病情进展和预后情况的首选指标。Objective To investigate the effect of APACHE Ⅱscore and plasma vWF level on lung injury and to assess the prognosis value of patients with acute respiratory distress syndrome（ARDS）.Methods Nintysix patients with ARDS were selected as the subjects admitted to author＇s hospital from May 2012 to December 2016.The clinical and follow-up data of all patients were analyzed by retrospective analysis.General clinical status and acute physiology and chronic health scoring system Ⅱ（APACHE Ⅱ）score,lung injury score,and plasma von Willebrand factor（vWF）levels were recorded among all ARDS patients according to the results of the data.The differences between the above data for different patients in ARDS were compared.Results（1）The scores of APACHE Ⅱ and vWF in the two groups were all higher at the 2 th day,and there was no difference,but they were significantly higher at the 3 rd day than that in the 1 th day,and the change values of1 th day to 3 rd day in the death group were significantly greater than those in the survival group,and the difference was statistically significant（P〈0.05）.（2）The score of lung injury in the survival group was lower than that in the death group on 1 th day,the PaO2/FiO2 level was higher than that in the death group.The lung injury score decreased in the survival group at the 3 rd day,but the score of lung injury was increased in the death group and the level of PaO2/FiO2 was still lower than that in the survival group.The differences were statistically significant（P〈0.05）.（3）A significant correlation was detected among APACHE Ⅱscore,vWF level and lung injury score,and all of them were positively correlated（P〈0.05）.（4）By ROC analysis,when the APACHE Ⅱ score was 28.6 points,the sensitivity and specificity（88.62% and 82.34%,respectively）were best for evaluating the prognostic value of ARDS patients,while the vWF level at 204.8%,the sensitivity and specificity（83.64% and 80.02%,respectively）were best for evaluating the prognostic val

关 键 词：急性呼吸窘迫综合征 APACHE Ⅱ评分 血浆vWF水平 预后评估 

分 类 号：R563.8[医药卫生—呼吸系统]