机械功对中重度急性呼吸窘迫综合征的诊断价值——基于MIMIC-Ⅲ数据库的资料分析  

Diagnostic value of mechanical power in patients with moderate to severe acute respiratory distress syndrome:an analysis using the data from MIMIC-Ⅲ

作　　者：颜瑶 谢永鹏 王言理 陈晓兵 孙艳[1] 杜志强[3] 李小民 Yan Yao;Xie Yongpeng;Wang Yanli;Chen Xiaobing;Sun Yan;Du Zhiqiang;Li Xiaomin(Department of Emergency Medicine,Lianyungang Clinical College of Nanjing Medical University,the First People's Hospital of Lianyungang City,Lianyungang 222000,Jiangsu,China;Department of Critical Care Medicine,Lianyungang Clinical College of Nanjing Medical University,the First People's Hospital of Lianyungang City,Lianyungang 222000,Jiangsu,China;Department of Critical Care Medicine,the Second People's Hospital of Lianyungang City,Lianyungang 222000,Jiangsu,China)

机构地区：[1]南京医科大学连云港临床医学院(连云港市第一人民医院)急诊科,江苏连云港222000 [2]南京医科大学连云港临床医学院(连云港市第一人民医院)重症医学科,江苏连云港222000 [3]连云港市第二人民医院重症医学科,江苏连云港222000

出　　处：《中华危重病急救医学》2022年第1期35-40,共6页Chinese Critical Care Medicine

基　　金：江苏省卫生健康委科研项目(H2019109);江苏省科技项目(BE2020670)。

摘　　要：目的基于美国重症监护医学信息数据库Ⅲv1.4(MIMIC-Ⅲv1.4)探讨机械功(MP)对中重度急性呼吸窘迫综合征(ARDS)的诊断价值。方法收集MIMIC-Ⅲv1.4数据库中2001年6月至2012年10月在美国马萨诸塞州波士顿贝丝以色列女执事医疗中心住院进行有创机械通气至少48 h的ARDS患者的相关资料。提取患者人口统计学信息、疾病严重程度评分、ARDS病因、预后指标、通气前动脉血气分析和通气48 h内呼吸力学参数等。以通气前氧合指数(PaO_(2)/FiO_(2))最低值将患者分为轻中度ARDS组(>150 mmHg,1 mmHg≈0.133 kPa)和中重度ARDS组(≤150 mmHg),比较两组间基线特征的差异。采用Logistic回归法分析与ARDS严重程度相关的独立危险因素;绘制受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC),评价MP对中重度ARDS的诊断价值,并用约登指数确定MP对中重度ARDS的诊断阈值。根据约登指数确定的MP最佳截点值将所有ARDS患者分为高MP组和低MP组,绘制Kaplan-Meier生存曲线,分析两组患者的28 d生存状态。结果共筛选出403例ARDS患者纳入分析,其中轻中度ARDS组107例,中重度ARDS组296例。两组患者年龄、序贯器官衰竭评分(SOFA)、通气前PaO_(2)/FiO_(2)最低值、通气前最后一次PaO_(2)/FiO_(2)、28 d病死率、重症监护病房(ICU)住院时间、机械通气时间、通气第2个24 h肺动态顺应性(Cdyn)及通气48 h内呼气末正压(PEEP)、平台压(Pplat)、驱动压(ΔP)、呼吸频率(RR)、肺静态顺应性(Cst)、MP、吸入氧浓度(FiO_(2))差异均有统计学意义。在调整了年龄、SOFA评分、通气前最后一次PaO_(2)/FiO_(2)及相关呼吸力学参数等变量后,多因素Logistic回归分析显示,更高的ΔP、PEEP、MP及更低的通气前最后一次PaO_(2)/FiO_(2)与中重度ARDS的发生独立相关〔优势比(OR)和95%可信区间(95%CI)分别为1.137(1.032~1.252)、1.333(1.139~1.561)、1.102(1.030~1.179)、0.996(0.993~0.998),均P<0.01〕。ROC曲线�Objective To explore the diagnostic value of mechanical power(MP)in patients with moderate to severe acute respiratory distress syndrome(ARDS)based on the Medical Information Mart for Intensive Care-Ⅲv1.4(MIMIC-Ⅲv1.4).Methods The information of ARDS patients undergoing invasive mechanical ventilation for no less than 48 hours who were hospitalized at Beth Israel Deaconess Medical Center in Boston,Massachusetts from June 2001 to October 2012 in the MIMIC-Ⅲv1.4 were collected.The demographics of patients,disease severity scores,ARDS etiology,prognostic indicators,pre-ventilation arterial blood gas analysis and respiratory parameters within 48 hours of ventilation were extracted.According to the lowest oxygenation index(PaO_(2)/FiO_(2))before ventilation,the patients were divided into mild to moderate ARDS group(>150 mmHg,1 mmHg≈0.133 kPa)and moderate to severe ARDS group(≤150 mmHg),and the differences in baseline characteristics between the two groups were compared.The independent predictors associated with the severity of ARDS were analyzed using Logistic regression.The receiver operator characteristic curve(ROC curve)was plotted.The area under ROC curve(AUC)was calculated to evaluate the diagnostic value of MP for moderate to severe ARDS.The Youden index was used to determine the diagnostic threshold of MP for moderate to severe ARDS.According to the cut-off value of MP based on Youden index,all ARDS patients were divided into high and low MP groups.Kaplan-Meier survival curve was used to analyze the 28-day survival status of patients.Results A total of 403 ARDS patients were enrolled in the study,including 107 subjects with mild to moderate ARDS and 296 with moderate to severe ARDS.There were significant differences in age,sequential organ failure assessment(SOFA)score,the lowest PaO_(2)/FiO_(2) before ventilation,the last PaO_(2)/FiO_(2) before ventilation,28-day mortality,the length of intensive care unit(ICU)stay,duration of mechanical ventilation,lung dynamic compliance(Cdyn)in the second 24 hours

关 键 词：机械功 急性呼吸窘迫综合征 诊断价值 MIMIC-Ⅲ 

分 类 号：R563.8[医药卫生—呼吸系统]