血管外肺水指数结合血乳酸清除率、APACHEⅡ评分对ARDS患者近期预后不良的预测价值  

Extractional pulmonary water index combined with blood lactic acid removal rate, Apache Ⅱ score for ARDS patients’ recent prognosis of poor prognosis

作　　者：韩虎 袁军[2] 李建国[1] HAN Hu;YUAN Jun;LI Jianguo(Department of Emergency Medicine,Hebei Provincial People’s Hospital,Shijiazhuang,Hebei 050051,China;Department of Hematology,Hebei Provincial People’s Hospital,Shijiazhuang,Hebei 050051,China)

机构地区：[1]河北省人民医院急诊医学科,石家庄050051 [2]河北省人民医院血液科,石家庄050051

出　　处：《重庆医学》2023年第3期321-325,332,共6页Chongqing medicine

基　　金：河北省卫生健康委员会医学科学研究重点课题计划项目(20170034)。

摘　　要：目的 研究血管外肺水指数(EVLWI)结合血乳酸清除率、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分对急性呼吸窘迫综合征(ARDS)患者近期预后不良的预测价值。方法 选取该院收治的ARDS患者126例作为研究对象,均检测EVLWI和血乳酸清除率,并评估APACHEⅡ评分。分析ARDS患者近期预后不良的影响因素,并分析EVLWI、血乳酸清除率和APACHEⅡ评分对ARDS患者近期预后不良的预测价值。结果 ARDS患者近期预后不良发生率为38.89%。近期预后不良患者EVLWI、APACHEⅡ评分均高于预后良好者,血乳酸清除率低于预后良好者,差异均有统计学意义(P<0.05)。年龄大、氧合指数和血乳酸清除率降低、肺血管通透指数(PVPI)、EVLWI和APACHEⅡ评分升高均是ARDS患者近期预后不良的危险因素(P<0.05);EVLWI、血乳酸清除率、APACHEⅡ评分联合预测ARDS患者近期预后不良的敏感度和曲线下面积(AUC)分别为97.96%、0.962,均高于单独预测(P<0.05),但其特异度(87.01%)与单独预测比较差异无统计学意义(P>0.05)。结论 EVLWI和APACHEⅡ评分增高及血乳酸清除率降低均可增加ARDS患者近期预后不良的风险,且均对ARDS近期预后不良具有一定预测效能,但三者联合价值更高。Objective To study the prediction value of extravascular lung water index(EVLWI) combined with blood lactate clearance rate and acute physiology and chronic health status scoring system Ⅱ(APACHEⅡ) score for poor short-term prognosis in patients with acute respiratory distress syndrome(ARDS).Methods A total of 126 ARDS patients admitted to this hospital were selected as the study objects.EVLWI and blood lactate clearance rate were detected, and APACHEⅡ score was evaluated.The influencing factors of poor short-term prognosis of ARDS was analyzed, and EVLWI,blood lactate clearance rate, and APACHEⅡ score for predictive value of short-term poor prognosis in ARDS patients were analyzed.Results The incidence of poor short-term prognosis in ARDS patients was 38.89%.The EVLWI and APACHE Ⅱ score of patients with poor short-term prognosis were higher than those with good prognosis, and the blood lactate clearance rate was lower than that of patients with good prognosis, and the differences were statistically significant(P<0.05).Old age, decreased oxygenation index and blood lactate clearance rate, increased pulmonary vascular permeability index(PVPI),EVLWI and APACHE Ⅱ score were all risk factors for poor short-term prognosis in ARDS patients(P<0.05).The sensitivity and area under the curve(AUC) of EVLWI,blood lactate clearance rate, and APACHE Ⅱ score combined to predict poor short-term prognosis in ARDS patients were 97.96% and 0.962,respectively, which were higher than those of single prediction(P<0.05).However, there was no significant difference in specificity(87.01%) compared with single prediction(P>0.05).Conclusion The increase of EVLWI and APACHE Ⅱ score and the decreased blood lactate clearance can increase the risk of poor short-term prognosis in ARDS patients, and all of them have certain predictive efficacy for poor short-term prognosis in ARDS patients, but the combined value of the three is higher.

关 键 词：血管外肺水指数 血乳酸清除率 急性生理学与慢性健康状况评分系统Ⅱ 急性呼吸窘迫综合征 预后 

分 类 号：R563.1[医药卫生—呼吸系统]