机械通气脓毒症患者肺部超声重力依赖失充气表型与不良预后的相关性  

Correlation between the lung ultrasound phenotype of gravity-dependent deaeration and poor prognosis in sepsis patients requiring mechanical ventilation

作　　者：王茜[1] 尹万红[1] 邹同娟 铁馨 朱俊臣[2] 陈侣林[2] 曾学英[1] Wang Qian;Yin Wanhong;Zou Tongjuan;Tie Xin;Zhu Junchen;Chen Lyulin;Zeng Xueying(Department of Critical Care Medicine,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Critical Care Medicine,Affiliated Hospital of Chengdu University,Chengdu 610081,China)

机构地区：[1]四川大学华西医院重症医学科,四川成都610041 [2]成都大学附属医院重症医学科,四川成都610081

出　　处：《临床荟萃》2024年第4期314-319,共6页Clinical Focus

基　　金：科学技术部国家重点研发计划感染性休克早期快速规范化诊疗体系和智能支持系统的建设(2022YFC2504504)。

摘　　要：目的分析脓毒症机械通气患者不同肺部超声表型的临床特征,探讨肺部超声重力依赖肺失充气表型对脓毒症机械通气患者不良预后的相关性。方法回顾性分析2019年4月至2020年10月四川大学华西医院重症医学科收治的机械通气脓毒症患者155例,按照28 d预后情况分为生存组(n=124)和死亡组(n=31),通过单因素和多因素Cox回顾分析肺部超声重力依赖失充气表型对患者28 d预后结局的影响。绘制Kaplan-Meier曲线分析重力依赖性和非重力依赖失充气表型与28 d预后生存的关系。结果单因素Cox回归分析发现,白细胞介素-6、SOFA评分、机械通气时间(h)、间质性失充气、实变性失充气、不张性失充气、存在重力依赖性失充气改变与患者28 d预后结局相关(P<0.05),进一步通过多因素Cox分析校正后发现存在间质性失充气肺部超声模式、机械通气时间和存在重力依赖性失充气改变与患者不良预后结局相关(P<0.05),重力依赖肺失充气表型的死亡风险是非重力依赖肺失充气表型的的2.003倍(HR=2.003,P=0.028,95%CI=1.112-6.387)。结论重力依赖肺失充气肺部超声表型可作为脓毒症机械通气患者不良预后的预测指标。Objective To analyze the clinical characteristics of sepsis patients requiring mechanical ventilation who presented varying lung ultrasound phenotypes,and to explore the correlation between the lung ultrasound phenotype of gravity-dependent deaeration and poor prognosis in this population.Methods This retrospective study involving 155 sepsis patients requiring mechanical ventilation who were admitted to the Department of Critical Care Medicine,West China Hospital,Sichuan University from April 2019 to October 2020.According to the 28-day prognosis,they were assigned into survival group(n=124)and death group(n=31).The influence of the lung ultrasound phenotype of gravity-dependent deaeration on the 28-day prognosis was analyzed by univariate and multivariate Cox analysis.Kaplan-Meier curves were plotted to analyze the correlation of gravity-dependent and non-gravity-dependent deaeration with 28-day prognosis of sepsis patients requiring mechanical ventilation.Results Univariate Cox regression analysis showed that interleukin-6(IL-6),Sequential Organ Failure Assessment(SOFA)score,mechanical ventilation time(h),interstitial deaeration,consolidation deaeration,atelectasis deaeration,and gravity-dependent deaeration changes were significantly correlated with 28-day prognosis(P<0.05).Multivariate Cox analysis with adjustment further identified the correlation of interstitial deaeration,mechanical ventilation time and gravity-dependent deaeration changes were significantly correlated with the poor prognosis of sepsis(P<0.05).The risk of death was 2.003 times greater for gravity-dependent lung deaeration than for non-gravity-dependent lung deaeration(HR=2.003,P=0.028,95%CI=1.112-6.387).Conclusion The lung ultrasound phenotype of gravity-dependent deaeration can be used as an independent risk factor for the prognosis of sepsis patients with mechanical ventilation.

关 键 词：脓毒症 肺部超声表型 重力依赖失充气 预后 

分 类 号：R563.8[医药卫生—呼吸系统]