机械能对急诊机械通气患者院内死亡风险的预测价值  

Predictive value of mechanical power on the in-hospital mortality in critical ill patients with mechanical ventilation in emergency department

作　　者：朱永城[1] 何鋆 陈晓辉[1] 王双卫 高贵锋 莫均荣[1] 王瑞强 李云妹[1] 冯雪珍[1] 江慧琳[1] 林珮仪[1] 李敏[1] Zhu Yongcheng;He Jun;Chen Xiaohui;Wang Shuangwei;Gao Guifeng;Mo Junrong;Wang Ruiqiang;Li Yunmei;Feng Xuezhen;Jiang Huilin;Lin Peiyi;Li Min(Department of Emergency,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China;AMBULANC(SHENZHEN)Tech.Co.,Ltd.,Shenzhen 518100,China)

机构地区：[1]广州医科大学附属第二医院急诊部,广州510260 [2]深圳安保公司,深圳518100

出　　处：《中华急诊医学杂志》2023年第8期1034-1038,共5页Chinese Journal of Emergency Medicine

基　　金：广州市急诊医学重点学科(2021-2023);广东省重点领域研发计划项目(2022B0303040002)。

摘　　要：目的探讨机械能(Mechanical Power,MP)对急诊机械通气患者院内死亡风险的预测价值。方法回顾性分析2017年12月1日至2020年10月31日期间广州医科大学附属第二医院急诊监护室收治的机械通气患者105例,根据临床预后分为院内生存组(80例)与院内死亡组(25例),记录两组各自的临床资料,呼吸机参数和计算机械能,评估机械能对院内死亡的预测效能。结果:与死亡组比较,生存组的PaO_(2)/FiO_(2)(271 vs.217,P=0.020)明显升高,血乳酸(1.59 mmol/L vs.2.56 mmol/L,P=0.000)、降钙素原(0.31 ng/mL vs.3.55 ng/mL,P=0.028)、分钟通气量(7.03 L/min vs.8.32 mmol/L,P=0.013)、机械能(14.37 J/min vs.16.12 J/min,P=0.041),以及SOFA评分(5 vs.8,P=0.001)和APACHEⅡ评分(16 vs.22,P=0.041)明显降低,差异均有统计学意义。经多因素Logistic回归分析显示PaO_(2)/FiO_(2)(OR=1.015,P=0.044)、MP(OR=1.813,P=0.0039)、SOFA评分(OR=2.651,P=0.01)是预测机械通气患者院内死亡的独立危险因素相关,其预测模型的ROC曲线下面积(AUC)分别为0.62、0.63和0.75,并且MP联合SOFA评分显著高于单独的MP(0.77 vs.0.63,P<0.05)。结论机械能与急诊机械通气患者院内死亡相关,机械能联合SOFA评分能提升预测效能。Objective To evaluate the predictive value of mechanical power(MP)on the risk of in-hospital mortality in critical ill patients in emergency department.Methods A total of 105 critical ill patients with invasive mechanical ventilation in the Department of Emergency of Second Affiliated Hospital of Guangzhou Medical University between December 1,2017 and October 31,2020 were retrospectively analyzed.Based on the clinical prognosis,the patients were divided into the in-hospital survival group(80 patients)and the in-hospital death group(25 patients).The clinical data and ventilator parameters were recorded,and the MP of the two groups was calculated in order to assess the predictive effi cacy of MP on in-hospital death.Results Compared to the in-hospital death group,the oxygenation index PaO_(2)/FiO_(2) was signifi cantly higher(271 mmHg vs.217 mmHg,P=0.020)and blood lactate(1.59 mmol/L vs.2.56 mmol/L,P=0.000)and procalcitonin(0.31 ng/mL vs.3.55 ng/mL,P=0.028),minute ventilation(7.03 L/min vs.8.32 mmol/L,P=0.013),MP(14.37 J/min vs.16.12 J/min,P=0.041),SOFA score(5 vs.8,P=0.001)and APACHE II score(16 vs.22,P=0.041)were signifi cantly lower in the inhospital survival group.Multivariate Logistic regression analysis showed that PaO_(2)/FiO_(2)(OR=1.015,P=0.044),MP(OR=1.813,P=0.0039)and SOFA score(OR=2.651,P=0.01)were independent risk factors for predicting hospital mortality in patients with mechanical ventilation.The areas under the ROC curves(AUC)were 0.62,0.63 and 0.75,respectively.Moreover,the MP combined with SOFA score for predicting in-hospital death was signifi cantly higher than that of MP alone(0.77 vs.0.63,P<0.05).Conclusions MP is associated with in-hospital death in patients with invasive mechanical ventilation in emergency department.MP combined with SOFA score can enhance its predictive efficacy.

关 键 词：机械能 机械通气 急诊室 预后评估 SOFA评分 

分 类 号：R459.7[医药卫生—急诊医学]