血乳酸、LCR联合无创血流动力学监测对慢性阻塞性肺疾病急性加重期合并呼吸衰竭患者预后的预测价值  

Prognostic Value of Blood Lactic Acid and Lactic Clearance Rate Combined with Non-invasive Hemodynamic Monitoring in Patients with Acute Exacerbation of COPD Complicated with Respiratory Failure

作　　者：钱晶 金小乐 QIAN Jing;JIN Xiaole(Department of Emergency,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院急诊科,河北张家口075000

出　　处：《转化医学杂志》2023年第5期235-240,共6页Translational Medicine Journal

基　　金：河北省卫生健康委员会医学科学研究计划项目(20231451)。

摘　　要：目的探讨血乳酸、血乳酸清除率(LCR)联合无创血流动力学监测预测慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭(RF)患者预后的临床价值。方法选择2022年1—12月收治的AECOPD合并RF 100例,入院后行常规治疗。统计28 d预后情况,分为预后不良组(死亡)、预后良好组(存活)。比较2组临床资料、血流动力学指标[心脏指数(CI)、心排血量(CO)、血管阻力指数(SVRI)、每搏量(SV)]、血乳酸、LCR,分析预后不良影响因素,并分析血流动力学指标、血乳酸、LCR预测AECOPD合并RF患者预后的价值,进一步通过曲线下面积(AUC)、净重新分类指数(NRI)、综合判别改善指数(IDI)评价含与不含血流动力学指标、血乳酸、LCR预测方案的预测效果。结果100例AECOPD合并RF患者28 d病死率为29.00%(29/100)。预后不良组年龄、急性加重次数≥2次/年占比、治疗24 h SVRI和血乳酸、LCR<10%占比高于预后良好组,机械通气时间、住院时间长于预后良好组,治疗24 h CI、CO、SV低于预后良好组(P<0.01)。年龄、急性加重次数、机械通气时间、治疗24 h SVRI和血乳酸均为AECOPD合并RF患者预后不良的影响因素,治疗24 h CI、CO、SV及LCR为保护因素(P<0.01)。治疗24 h CI、CO、SVRI、SV、血乳酸及LCR预测预后不良的AUC为0.778、0.767、0.779、0.814、0.804、0.909。含血流动力学指标、血乳酸、LCR预测方案的AUC大于常规预测方案的AUC(P<0.05)。进一步通过NRI、IDI分析显示,与常规预测方案比较,含血流动力学指标、血乳酸、LCR预测方案的预测效果有明显改善(P<0.05)。结论血乳酸、LCR联合无创血流动力学监测在预测AECOPD合并RF患者预后方面具有良好效能。Objective To investigate the clinical value of blood lactic acid and blood lactic acid clearance(LCR)combined with non-invasive hemodynamic monitoring in predicting prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure(RF).Methods A total of 100 patients with AECOPD complicated with RF admitted from January to December 2022 were selected for conventional treatment after admission.The 28-day prognosis was recorded and they were divided into poor prognosis(death)group and good prognosis(survival)group.Clinical data,hemodynamic indexes[cardiac index(CI),cardiac output(CO),systemic vascular resistance index(SVRI),stroke volume(SV)],blood lactic acid and blood LCR of the two groups were compared,and adverse prognostic factors were analyzed.The prognostic value of hemodynamic indexes,blood lactic acid,and LCR in patients with AECOPD and RF was analyzed.The predictive effect of the prediction schemes with and without hemodynamic indexes,blood lactic acid,and LCR was further evaluated by area under the receiver operating characteristic(AUC)curve,net reclassification index(NRI),and integrated discriminant improvement index(IDI).Results The 28-day fatality rate of 100 patients with AECOPD combined with RF was 29.00%(29/100).The proportion of age,acute exacerbations≥2 times/year,the proportion of SVRI,blood lactic acid and LCR<10%at 24 h after treatment in the poor prognosis group were higher than those in the good prognosis group,the duration of mechanical ventilation and length of hospital stay were longer than those in the good prognosis group,and the CI,CO and SV at 24 h after treatment were lower than those in the good prognosis group(P<0.01).Age,number of acute exacerbations,duration of mechanical ventilation,as well as SVRI and blood lactic acid at 24 h after treatment were influencing factors of poor prognosis in AECOPD patients with RF,while CI,CO,SV and LCR at 24 h after treatment were protective factors(P<0.01).At 24 h after treatment,

关 键 词：肺疾病 慢性阻塞性 呼吸功能不全 血乳酸 血乳酸清除率 血管阻力指数 心排血量 预后 综合判别改善指数 

分 类 号：R563.9[医药卫生—呼吸系统]