呼吸衰竭患者体外膜肺氧合治疗后心率、氧合指数改变及APACHEⅡ与SOFA评分对预后的预测价值  

Values of changes of heart rate and oxygenation index after extracorporeal membrane oxygenation and scores of APACHEⅡand SOFA in prognostic prediction in patients with respiratory failure

作　　者：袁法伟[1] 冯辉斌[1] 尹欢[2] 郑鲲[1] 梅喜平[1] 袁利学[1] 祝小梅[1] Yuan Fawei;Feng Huibin;Yin Huan;Zheng Kun;Mei Xiping;Yuan Lixue;Zhu Xiaomei(Intensive Care Unit,Huangshi Central Hospital,Edong Healthcare Group(Affiliated Hospital of Hubei Polytechnic University),Huangshi 435000,China;Intensive Care Unit of Neonatology,Huangshi Maternal and Child Health Hospital,Edong Healthcare Group,Huangshi 435000,China)

机构地区：[1]鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)重症医学科,黄石435000 [2]鄂东医疗集团黄石市妇幼保健院新生儿科重症监护室,黄石435000

出　　处：《国际医药卫生导报》2022年第10期1338-1342,共5页International Medicine and Health Guidance News

基　　金：湖北省卫生健康委员会联合基金项目(面上项目)(WJ2019H461)。

摘　　要：目的探究呼吸衰竭患者体外膜肺氧合(ECMO)治疗后心率、氧合指数(PaO_(2)/FiO_(2))改变及急性生理学及慢性健康状况评分系统(APACHEⅡ)与序贯器官衰竭评估(SOFA)评分对预后的预测价值。方法选取2016年2月至2021年2月在黄石市中心医院接受ECMO治疗的84例呼吸衰竭患者进行回顾性分析,男45例、女39例,年龄(43.28±9.59)岁。以接受ECMO支持后180 d为研究终点,分为生存组(39例)和死亡组(45例),比较两组心率、PaO_(2)/FiO_(2)、APACHEⅡ评分、SOFA评分及临床资料的差异;采用多因素logistic回归分析患者预后的影响因素;采用受试者工作特征曲线(ROC)分析以上指标对患者预后的预测价值。计数资料行χ^(2)检验,计量资料行独立样本t检验。结果多因素logistic回归分析结果显示,ECMO支持治疗时间过短、APACHEⅡ评分较高、SOFA评分较高、PaO_(2)/FiO_(2)降低及心率较快为患者死亡的影响因素(OR=0.802、1.630、2.010、1.127、1.132,均P<0.05)。ROC分析结果显示,心率、PaO_(2)/FiO_(2)、SOFA评分、APACHEⅡ评分及四项联合指标预测患者预后曲线下面积(AUC)分别为0.855、0.858、0.863、0.857、0.991,可知四项联合指标预测患者预后的价值高于单项指标,其灵敏度、特异度分别为95.6%、100.0%。结论心率、PaO_(2)/FiO_(2)改变及APACHEⅡ与SOFA评分为呼吸衰竭患者ECMO治疗后预后的影响因素,同时对其预后有较好的预测价值,四项联合检测可以提高预测此类患者预后的准确度、灵敏度,值得在临床推广。Objective To explore the values of changes of heart rate and oxygenation index(PaO_(2)/FiO_(2))after extracorporeal membrane oxygenation(ECMO)and scores of Acute Physiology and Chronic Health Evaluation(APACHEⅡ)and Sequential Organ Failure Assessment(SOFA)in prognostic prediction in patients with respiratory failure.Methods A retrospective analysis was performed on 84 patients with respiratory failure who received ECMO treatment in Huangshi Central Hospital from February 2016 to February 2021,including 45 males and 39 females,aged(43.28±9.59)years.Taking 180 days after receiving ECMO support as the research endpoint,they were divided into a survival group(39 cases)and a death group(45 cases).The differences in heart rate,PaO_(2)/FiO_(2),APACHEⅡscore,SOFA score,and clinical data were compared between the two groups;multivariate logistic regression analysis was used to analyze the factors affecting the patients'prognosis;the receiver operating characteristic curve(ROC)was used to analyze the predictive values of the above indicators on the patients'prognosis.The count data were tested byχ^(2) test,and the measurement data were tested by independent sample t test.Results The results of the multivariate logistic regression analysis showed that too short ECMO support duration,high APACHEⅡscore,high SOFA score,reduced PaO_(2)/FiO_(2),and high heart rate were influencing factors of death(OR=0.802,1.630,2.010,1.127,1.132;all P<0.05).The results of the ROC analysis showed that the areas under curve(AUC)of heart rate,PaO_(2)/FiO_(2),SOFA score,APACHEⅡscore,and combination of the four indicators in predicting patients'prognosis were 0.855,0.858,0.863,0.857,and 0.991,respectively,indicating that the combination of the four indicators had a higher prognostic value than single indicator,with a sensitivity of 95.6%and a specificity of 100.0%,respectively.Conclusions Changes in heart rate,PaO_(2)/FiO_(2),SOFA score,and APACHEⅡscore are influencing factors of the prognosis in patients with respiratory failure after EC

关 键 词：呼吸衰竭 体外膜肺氧合 心率 氧合指数 APACHEⅡ SOFA 

分 类 号：R563.8[医药卫生—呼吸系统]