血管外肺水含量变化与急性呼吸窘迫综合征患者预后的临床研究  

Clinical study on extrtravascular lung water content and prognosis of patients with acute respiratory distress syndrome

作　　者：宗立永 刘爱敏 丁士芳[3] 吴大玮[3] 李琛[3] 翟茜[3] 杜滨锋[3] 李远[3] Zong Liyong;Liu Aimin;Ding Shifang;Wu Dawei;Li Chen;Zhai Qian;Du Binfeng;Li Yuan(Department of Critical Care Medicine,Huantai County People's Hospital,Zibo 256400,China;Department of Critical Care Medicine,Shandong Provincial Third Hospital,Ji'nan 250031,China;Department of Critical Care Medicine,Qilu Hospital of Shandong University,Ji'nan 250000,China)

机构地区：[1]桓台县人民医院重症医学科,山东淄博256400 [2]山东省立第三医院重症医学科,济南250031 [3]山东大学齐鲁医院重症医学科,济南250000

出　　处：《中华危重症医学杂志（电子版）》2021年第5期380-385,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：国家临床重点专科建设项目(2011-873);山东省自然科学基金项目(ZR2013HM088);天普研究基金项目(UF201304)。

摘　　要：目的观察急性呼吸窘迫综合征(ARDS)患者住院期间血管外肺水指数(EVLWI)和肺血管通透性指数(PVPI)对ARDS患者预后的预测价值。方法回顾性分析2010年1月至2017年12月入住山东大学齐鲁医院ICU的71例ARDS患者,根据患者预后情况,将其分为存活组(29例)和死亡组(42例)。比较两组患者的一般资料、液体平衡量及机械通气设置情况。采用多因素Logistic回归分析影响ARDS患者预后的危险因素;绘制受试者工作特征(ROC)曲线,评价各影响因素对ARDS患者预后的诊断价值。结果存活组和死亡组患者年龄、免疫功能低下病史、脓毒性休克、连续肾脏替代疗法(CRRT)、肺源性ARDS、重度ARDS、7 d总液体平衡量、前3天EVLWI和PVPI、动脉血二氧化碳分压、气道峰压以及氧合指数比较,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析结果显示,年龄[比值比(OR)=1.190,95%置信区间(CI)(1.053,1.346),P=0.005]、免疫功能低下病史[OR=0.076,95%CI(0.006,0.925),P=0.011]、第1天EVLWI[OR=1.078,95%CI(0.978,1.188),P=0.013]、第2天EVLWI[OR=1.109,95%CI(1.014,1.214),P=0.023]、第3天EVLWI[OR=1.115,95%CI(1.015,1.226),P=0.024]、第1天PVPI[OR=2.048,95%CI(1.167,3.595),P=0.012]、第2天PVPI[OR=2.070,95%CI(1.187,3.611),P=0.010]、第3天PVPI[OR=2.366,95%CI(1.271,4.404),P=0.007]、氧合指数[OR=0.973,95%CI(0.957,0.989),P=0.002]是影响ARDS患者预后的独立危险因素,CRRT[OR=10.404,95%CI(1.709,63.347),P=0.001]则是其保护因素。ROC曲线分析结果显示,年龄[曲线下面积(AUC)=0.677,95%CI(0.546,0.809),P=0.013]、免疫功能低下病史[AUC=0.641,95%CI(0.512,0.770),P=0.048]、CRRT[AUC=0.711,95%CI(0.573,0.792),P=0.046]、第1天EVLWI[AUC=0.743,95%CI(0.607,0.861),P=0.001]、第2天EVLWI[AUC=0.763,95%CI(0.641,0.884),P<0.001]、第3天EVLWI[AUC=0.734,95%CI(0.613,0.855),P=0.001]、第1天PVPI[AUC=0.711,95%CI(0.586,0.837),P=0.004]、第2天PVPI[AUC=0.755,95%CI(0.633,0.877),P<0.001]、第3天PVPI[AUC=0.793,95%CI(0.686,0.901),P<0.Objective To observe the prognostic value of extravascular lung water index(EVLWI)and pulmonary vascular permeability index(PVPI)in patients with acute respiratory distress syndrome(ARDS)during hospitalization.Methods A total of 71 patients with ARDS admitted to the ICU of Qilu Hospital of Shandong University from January 2010 to December 2017 were retrospectively analyzed.According to their prognosis,71 patients were divided into a living group(n=29)and a death group(n=42).The general data,fluid balance volume and mechanical ventilation settings were compared between the two groups.Multivariate Logistic regression was used to analyze risk factors influencing the prognosis of ARDS patients,and the receiver operating characteristic(ROC)curve was drawn to evaluate their diagnostic value.Results The age,immune dysfunction,septic shock,continuous renal replacement therapy(CRRT),lung-derived ARDS,severe ARDS,total fluid balance of 7 d,EVLWI and PVPI at the first 3 days,arterial partial pressure of carbon dioxide,airway peaks and oxygenation index were statistically significantly different between the living group and death group(all P<0.05).Multivariate Logistic regression analysis showed that the age[odds ratio(OR)=1.190,95%confidence interval(CI)(1.053,1.346),P=0.005],immune dysfunction[OR=0.076,95%CI(0.006,0.925),P=0.011],EVLWI on day 1[OR=1.078,95%CI(0.978,1.188),P=0.013],EVLWI on day 2[OR=1.109,95%CI(1.014,1.214),P=0.023],EVLWI on day 3[OR=1.115,95%CI(1.015,1.226),P=0.024],PVPI on day 1[OR=2.048,95%CI(1.167,3.595),P=0.012],PVPI on day 2[OR=2.070,95%CI(1.187,3.611),P=0.010],PVPI on day 3[OR=2.366,95%CI(1.271,4.404),P=0.007]and oxygenation index[OR=0.973,95%CI(0.957,0.989),P=0.002]were independent risk factors influencing the prognosis of ARDS patients,while CRRT[OR=10.404,95%CI(1.709,63.347),P=0.001]was the protective factor.ROC curve analysis showed that the age[area under the curve(AUC)=0.677,95%CI(0.546,0.809),P=0.013],immune dysfunction[AUC=0.641,95%CI(0.512,0.770),P=0.048],CRRT[AUC=0.711,95%CI(0.573,0.792),P=

关 键 词：急性呼吸窘迫综合征 血管外肺水指数 肺血管通透性指数 机械通气 预后 

分 类 号：R563.8[医药卫生—呼吸系统]