肺水肿影像评分评估静脉-动脉体外膜肺氧合患者预后的价值  

The value of influence of radiographic assessment of lung edema on the prognosis of venoarterial extracorporeal membrane oxygenation

作　　者：任英杰 刘蓉安[2] 黎嘉嘉[2] 罗小秀 黄晓波 REN Ying-jie;LIU Rong-an;LI Jia-jia;LUO Xiao-xiu;HUANG Xiao-bo(North Sichuan Medical College,Nanchong 637100,China;Sichuan Academy of Medical Science&Sichuan Provincial People′s Hospital,Chengdu 610072,China)

机构地区：[1]川北医学院,四川南充637100 [2]四川省医学科学院·四川省人民医院,四川成都610072

出　　处：《实用医院临床杂志》2023年第6期165-170,共6页Practical Journal of Clinical Medicine

基　　金：四川省科技厅重点研发项目(编号:2017SZ0138,20ZDYF1870)。

摘　　要：目的评估肺水肿影像(RALE)评分评价静脉-动脉体外膜肺氧合(VA-ECMO)患者预后的价值。方法分析79例难治性心源性休克或难治性心脏骤停而接受VA-ECMO患者的数据,评估人口统计学、临床数据和评估肺水肿的RALE评分,采用生存分析和受试者工作特征曲线(ROC)评估RALE评分对预后的价值。结果存活组31例,死亡组48例。存活组患者年龄更小,基础合并症更少,白细胞计数以及中性粒细胞计数低于死亡组。存活组的RALE评分显著低于死亡患者(P<0.05)。ROC分析显示,RALE评分预测死亡率的曲线下面积(AUC)为0.798,与SAVE评分比较,差异无统计学意义(P<0.05)。存活者VA-ECMO上机后24、72 h液体平衡明显小于死亡者(P<0.001)。Kaplan Meier生存曲线上显示VA-ECMO上机后24、72 h后液体负平衡患者预后优于液体正平衡患者(P<0.05)。结论RALE评分在预测因难治性心源性休克或难治性心脏骤停而接受VA-ECMO治疗的患者的临床结局方面有一定的价值。Objective To evaluate the diagnostic value of Radiographic Assessment of Lung Edema(RALE)score in refractory cardiogenic shock patients with venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods The data of 79 patients with refractory cardiogenic shock or refractory cardiac arrest undergoing VA-ECMO were analyzed.The demographics,clinical data and RALE score for pulmonary edema were evaluated.Survival analysis and receiver operating characteristics(ROC)curve analysis were used to evaluate the prognostic value of RALE score.Results There were 31 patients in the survival group and 48 in the death group.Patients in the survival group were younger,had fewer underlying comorbidities and lower white blood cell counts and neutrophil counts than those in the death group.The RALE score of the surviving group was significantly lower than that of the deceased patients.In ROC analysis,the area under the curve(AUC)predicted by RALE score was 0.798 that was not significantly different from that of SAVE score(P<0.05).The liquid balance of the survivors after 24 and 72 hours of VA-ECMO was significantly lower than that of the dead(P<0.001).According to the Kaplan-Meier survival curve,the patients with negative fluid balance had a better prognosis after 24 and 72 hours of VA-ECMO(P<0.05).Conclusions RALE score has a certain value in predicting the clinical outcome of patients treated with VA-ECMO for refractory cardiogenic shock or refractory cardiac arrest.

关 键 词：体外膜肺氧合 肺水肿 心源性休克 肺水肿影像评分 

分 类 号：R541.64[医药卫生—心血管疾病]