有创机械通气病死率预测评分对有创机械通气患者是否获益的预测价值  

Value of invasive mechanical ventilation mortality prediction score to predict whether patients would benefit from invasive mechanical ventilation

作　　者：汪正光 姚建华[1] 陈晓燕[1] 汪国斌[1] 闫晓玲[1] WANG Zheng-guang;YAO Jian-hua;CHEN Xiao-yan;WANG Guo-bin;YAN Xiao-ling(Department of Critical Care Medicine,Huangshan Shoukang Hospital,Huangshan,Anhui 245400,China)

机构地区：[1]黄山首康医院重症医学科,安徽黄山245400

出　　处：《临床肺科杂志》2021年第9期1379-1383,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨有创机械通气病死率预测评分(Invasive Mechanical Ventilation Mortality Prediction Score,IMPRES)对重症医学科(Intensive Care Units,ICU)有创机械通气患者是否受益的预测价值,并与急性生理与慢性健康评分Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)、牛津急性疾病严重程度评分(Oxford Acute Severity of Illness Score,OASIS)比较。方法回顾性分析2018年3月—2019年12月收入我院ICU行有创机械通气患者的临床资料,按转归分为获益组(经治疗好转转科或出院)和非获益组(治疗无效死亡),利用受试者工作特征曲线下面积(Area under the Receiver Operating Characteristic curve,AUC)比较三种评分对ICU有创机械通气患者是否受益的预测价值。结果103例患者被纳入研究,男63例(61.17%),女40例(38.83%),获益组68例和非获益组35例。IMPRES评分的AUC为0.850(95%可信区间:0.765~0.934,P<0.001),评分4.75时Youden指数最大,为0.556,敏感性0.600,特异性0.956。APACHEⅡ评分的AUC为0.682(95%可信区间:0.570~0.795,P=0.003),评分22.5时Youden指数最大,为0.361,敏感性0.743,特异性0.618。OASIS评分的AUC为0.710(95%可信区间:0.602~0.818,P=0.001),评分26.5时Youden指数最大,为0.330,敏感性0.771,特异性0.559。IMPRES评分的AUC高于APACHEⅡ评分(Z=2.531,P=0.011)和OASIS评分(Z=2.117,P=0.034),差异有统计学意义。APACHEⅡ评分和OASIS评分的AUC比较差异无统计学意义(Z=0.316,P=0.752)。IMPRES评分<2分、2.1分~5分、5.1分~8分、>8分时,分别有8.00%、23.64%、92.86%、77.78%的患者不能获益。结论IMPRES评分≥5.1分时,患者从有创机械通气获益的机会可能会减少,有待前瞻性大样本研究进一步证实。Objective To explore the value of invasive mechanical ventilation mortality prediction score(IMPRES)to predict whether patients admitted to intensive care units(ICU)would benefit from invasive mechanical ventilation,and to compare with acute physiology and chronic health evaluationⅡ(APACHEⅡ),and oxford acute severity of illness score(OASIS).Methods All adult patients requiring invasive mechanical ventilation who were admitted to ICU from March 2018 to December 2019 were retrospectively analyzed.Patients who died during their ICU stay were categorized as the group that did not benefited from invasive mechanical ventilation,namely the non-benefited group.The surviving patients(e.g.,transferred to a ward,discharged to home)were categorized as the benefited group.The value of three scores to predict whether patients would benefit from invasive mechanical ventilation was evaluated by the area under the receiver operating characteristic curve(AUC).Results Of the 103 patients enrolled,63 cases(61.17%)were male and 40 cases were female(38.83%),and 65 cases were in the benefited group and 38 cases were in the non-benefited group.The AUC of IMPRES was 0.850(95%CI:0.765~0.934,P<0.001).When the score of IMPRES was 4.75,Youden index was the highest(0.556),and the sensitivity and specificity were 0.600 and 0.956,respectively.The AUC of APACHEⅡwas 0.682(95%CI:0.570~0.795,P=0.003).When the score of APACHEⅡwas 22.5,Youden index was highest(0.361),and the sensitivity and specificity were 0.743 and 0.618,respectively.The AUC of OASIS was 0.710(95%CI:0.602~0.818,P=0.001).When the score of OASIS was 26.5,Youden index was the highest(0.330),and the sensitivity and specificity were 0.771 and 0.559,respectively.The AUC of IMPRES was significantly higher than APACHEⅡand OASIS respectively,(Z=2.531,P=0.011;Z=2.117,P=0.034).The difference in AUC between APACHEⅡand OASIS was not significant(Z=0.316,P=0.752).There were 8.00%,23.64%,92.86%,77.78%patients who would not benefit from invasive mechanical ventilation respectively when

关 键 词：有创机械通气病死率预测评分 急性生理与慢性健康评分Ⅱ 牛津急性疾病严重程度评分 机械通气 价值 

分 类 号：R459.7[医药卫生—急诊医学]