简化急性生理评分-3在中重度急性呼吸窘迫综合征患者选择皮质醇激素治疗中的作用  

The important role of simplified acute physiological score-3 in early corticosteroid treatment for patients with acute respiratory distress syndrome

作　　者：刘辉 肖建国 胡新 王黎 周飞虎 Liu Hui;Xiao Jianguo;Hu Xin;Wang Li;Zhou Feihu(Critical Care Medicine Department,1st Medical Center,Chinese People s Liberation Army of China General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心重症医学科,北京100853

出　　处：《首都医科大学学报》2021年第6期915-922,共8页Journal of Capital Medical University

基　　金：国家老年疾病临床医学研究中心课题(ZXD2002)。

摘　　要：目的探讨简化急性生理评分-3(Simplified Acute Physiological Score-3,SAPS-3)在甄别可能从早期皮质醇激素治疗中获益的急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者的作用。方法分析电子重症医疗单元合作研究数据库(electronic intensive care unit collaborative research database,eICU-CRD)的临床资料。选取中重度ARDS患者,通过生存分析的方法明确了SAPS-3的诊断阈值,然后应用SAPS-3阈值将患者按病情严重程度分为2组。进一步应用倾向性评分匹配(propensity score matching analysis,PSMA)去除相关混杂因素后,分别比较2组患者在ARDS诊断3 d内应用皮质醇激素和没有应用皮质醇激素对于患者呼吸机使用时间的影响。结果筛选3234名及时接受皮质醇激素治疗的ARDS患者,1122名没有及时接受皮质醇激素治疗的患者。经过倾向性评分匹配后进行对比显示,在SAPS-3≤70的患者中,皮质醇激素治疗不影响患者的呼吸机辅助时间;在SAPS-3>70的患者中,接受早期皮质醇激素治疗的患者呼吸机使用时间明显缩短[(5.2±5.6)d vs(6.5±5.9)d,P<0.001],但是2组的病死率差异没有统计学意义。结论SAPS-3有助于鉴别从早期皮质醇激素治疗中获益的呼吸机辅助ARDS患者。Objective To investigate the role of Simplified Acute Physiological Score-3(SAPS-3)in spotting who was likely to benefit from early corticosteroid treatment in patients with acute respiratory distress syndrome(ARDS).Methods Electronic intensive care unit collaborative research database(eICU-CRD)was used to extract data about moderate or severe ARDS patients.After the cut-off value of SAPS-3 was identified,accordingly,the enrolled patients were divided into two groups.Propensity score matching analysis(PSMA)was used to remove confounding factors before comparing the effect of early corticosteroid treatment in ARDS patients.Results There were 3234 ARDS patients with early corticosteroid treatment and 1122 ARDS patients without this treatment.After propensity score matching analysis(PSMA),the data showed that ARDS patients with SAPS-3>70 had a shorter duration of mechanical ventilation after early corticosteroid treatment[(5.2±5.6)d vs(6.5±5.9)d,P<0.001),compared with the patients with SAPS-3≤70.There was no difference in mortality whether early corticosteroid treatment was applied or not.Conclusion The ARDS patients with SAPS-3>70 were likely to benefit from early corticosteroid treatment.

关 键 词：电子重症医疗单元合作研究数据库 皮质醇激素 急性呼吸窘迫综合征 简化急性生理评分-3 

分 类 号：R56[医药卫生—呼吸系统]