机械通气压力参数对急性呼吸窘迫综合征预后评估的研究  

Investigation of mechanical ventilation pressure parameters’effect on the prognosis of acute respiratory distress syndrome

作　　者：张文博 蒋宇 刘晓伟[1] 刘志[1] Zhang Wenbo;Jiang Yu;Liu Xiaowei;Liu Zhi(Emergency Department,the First Hospital of China Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学附属第一医院急诊科,沈阳110000

出　　处：《中华急诊医学杂志》2020年第1期121-125,共5页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金(81772053)。

摘　　要：目的比较机械通气中的压力参数与传统氧合指数的差别并找出在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)预后评估中可能存在的最优指标。方法回顾性分析2018年1月至2018年12月中国医科大学附属第一医院急诊监护室(EICU)收治的经口气管插管呼吸机辅助通气的符合ARDS柏林诊断标准的患者的临床资料。排除留观时间过短(<48 h)及无法配合治疗的患者。根据患者的28 d生存情况,将其分为生存组与死亡组,使用LSD-t检验或者秩和检验比较两组患者在基本信息、SOFA评分、非呼吸系统SOFA评分(nR-SOFA)、氧合指数、呼气末正压、平台压、驱动压、平均气道压以及机械通气压力参数与氧合指数的比值之间的差异。结果共有147例纳入到本次研究中,117例被纳入到最终的分析中。总的28 d病死率为31.62%(n=37)。生存组和死亡组患者在性别、年龄、体质量指数、初始动脉血氧分压及二氧化碳分压均差异无统计学意义(均P>0.05),而在基础状态上存在显著差别[SOFA评分:6.53±2.96 vs 8.65±3.00;nR-SOFA:3.44±2.98 vs 5.27±2.86],差异有统计学意义(均P<0.05)。在评价指标中,平台压氧指数(plateau pressure oxygenation index,PPOI)ROC曲线下面积0.828,敏感度为86.5%,特异度为71.2%。SOFA评分的ROC曲线下面积为0.707,而PPOI联合SOFA评分的ROC曲线下面积为0.833。结论机械通气压力参数可以辅助预测ARDS患者的预后,将平台压与氧合指数相结合可能更及时、简便、实时地评估ARDS预后。Objective To find out whether we can get the optimality in the prognosis of acute respiratory distress syndrome(ARDS)by combing the pressure parameters in mechanical ventilation with traditional PaO2/FiO2.Methods This is a retrospective study.Patients included here were diagnosed as ARDS in the Emergency Unit(EICU)of the First Affiliated Hospital of China Medical University from January 2018 to December 2018.All the patients were intubated and mechanically ventilated.Patients with a short observation time(<48 h)or unable to cooperate with treatment were excluded.According to the patient's 28-day survival,patients were divided into the survival and non-survival groups.Parameters in the two groups such as basic characteristics,SOFA score,non-respiratory system SOFA score(nR-SOFA),and PaO2/FiO2 were analyzed with LSD-t test or rank sum test.Simultaneously,plateau pressure,driving pressure,mean airway pressure and the ratio of these mechanical ventilation pressure parameters to the PaO2/FiO2 were also analyzed.Results A total of 147 patients were included in the study and 117 of them were analyzed.The overall 28-day mortality was 31.62%(n=37).There were no significant differences in gender,age,body mass index,initial arterial oxygen partial pressure and carbon dioxide partial pressure between the survival group and non-survival groups(P>0.05).But there was a significant difference in SOFA score(6.53±2.96 vs 8.65±3.00)and nR-SOFA(3.44±2.98 vs 5.27±2.86).Among the evaluation indexes,the PPOI obtained the AUC of 0.828,with the sensitivity of 86.5%,and specificity of 71.2%.The AUC of the SOFA score was 0.707,while the AUC of the PPOI combined with the SOFA score was 0.833.Conclusion Mechanical ventilation pressure parameters can be used to predict the prognosis of patients with ARDS.PPOI may evaluate the prognosis of ARDS in a more simple,timely and real-time manner.

关 键 词：急性呼吸窘迫综合征 平台压 驱动压 平均气道压 平台压氧指数 预后 

分 类 号：R563[医药卫生—呼吸系统]