APACHEⅡ评分、PaO_(2)/FiO_(2)与24h血乳酸清除率对ARDS患者病情及预后评估效能  

The Efficacy of APACHEⅡ Score,PaO_(2)/FiO_(2) and 24 h Blood Lactate Clearance in Assessing the Condition and Prognosis of Patients with ARDS

作　　者：代琴 许天祥 王晓霞 岳阳 吕红旭 DAI Qin;XU Tianxiang;WANG Xiaoxia;YUE Yang;YU Hongxu(Graduate School of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014040 China;Inner Mongolia People's Hospital,Abdominal Tumor Surgery,Hohhot 010017 China;Inner Mongolia People's Hospital,Critical Care Medicine,Hohhot 010017 China;Graduate School of Inner Monglia Medical University,Hohhot 010110 China)

机构地区：[1]内蒙古科技大学包头医学院研究生院,内蒙古包头014040 [2]内蒙古自治区人民医院腹部肿瘤外科,呼和浩特010017 [3]内蒙古自治区人民医院重症医学科,呼和浩特010017 [4]内蒙古医科大学研究生院,呼和浩特010110

出　　处：《内蒙古医学杂志》2024年第7期880-884,889,共6页Inner Mongolia Medical Journal

基　　金：内蒙古医科大学联合项目(编号:YKD2022LH015);内蒙古自治区自然科学基金(编号:2023MS08019);内蒙古自治区卫生健康科技计划项目(编号:202201011);内蒙古自治区公立医院科研联合基金科技项目(编号:2023GLLH0012);内蒙古自治区人民医院院内基金(编号:2020YN06);内蒙古自治区人民医院博士科研启动基金(编号:2020BS06)。

摘　　要：目的探讨急性生理与慢性健康评分(APACHEⅡ评分)、氧合指数(PaO_(2)/FiO_(2))与24h血乳酸清除率对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者病情预后评估效能。方法采用回顾性研究分析方法,收集2022年9月至2023年11月在内蒙古自治区人民医院重症医学科住院治疗的76例ARDS患者的临床资料,根据28d临床结局将其分为生存组(43例)和死亡组(33例)。比较两组的一般资料、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血乳酸(Lactate,Lac)、24h血乳酸清除率、PaO_(2)/FiO_(2)、序贯器官衰竭评分(SOFA评分)和APACHEⅡ评分。记录患者机械通气时间、住院时间及预后。采用多因素一般Logistic回归模型分析ARDS患者28d内预后不良的影响因素,采用受试者工作特征(ROC)曲线评估APACHEII评分、PaO_(2)/FiO_(2)及24h血乳酸清除对ARDS患者28d内不良预后风险的预测价值。结果两组的年龄、性别、身体质量指数(BMI)、ARDS病因、基础疾病、吸烟史、白细胞计数、血小板计数、抗菌药物使用时间比较,差异无统计学意义(P>0.05);Logistics回归分析结果显示影响ARDS28d内预后的危险因素为APACHEII评分(P<0.001OR:1.988,95%CI:1.361~2.904)、SOFA评分(P<0.001,OR:1.496,95%CI:1.211~1.849)、PaO_(2)/FiO_(2)(P<0.001,OR:1.068,95%CI:1.032~1.105)、24h血乳酸清除(P<0.001,OR:1.396,95%CI:1.182~1.650)及NLR(P=0.006,OR:1.185,95%CI:0.964~1.457);两组APACHEⅡ评分、24h血乳酸清除及PaO_(2)/FiO_(2)比较,差异具有统计学意义(P<0.001),其AUC分别为0.878、0.814、0.682,敏感度为84.80%、81.80%、42.40%,特异度为76.74%、65.12%、95.35%;阳性预测值为73.68%、58.18%、87.50%,阴性预测值为86.84%、95.24%、69.49%,3者联合预测的AUC为0.963、敏感度为97%、特异度为95.35%。结论APACHEⅡ评分、PaO_(2)/FiO_(2)增高及24h血乳酸清除率降低均可增加ARDS患者病情预后不良风险,且均对ARDS患者不良预后具有一Objective To investigate the efficacy of APACHEⅡ score,PaO_(2)/FiO_(2) and 24 h blood lactate clearance on the prognosis of patients with acute respiratory distress syndrome(ARDS).Methods A retrospective study was conducted to collect the clinical data of 76 patients with ARDS who were hospitalized in the Department of Intensive Care Medicine of the Inner Mongolia Autonomous Region People's Hospital from September 2022 to November 2023,and the patients were classified into 43 survivors and 33 deaths according to the clinical outcomes in the 28-d period.The general data,neutrophil to lymphocyte ratio(NLR),blood lactate(Lactate,Lac),24 h blood lactate clearance,oxygenation index(PaO_(2)/FiO_(2)),sequential organ failure score(SOFA score),and acute physiologic and chronic health score(APACHEⅡ score).The duration of mechanical ventilation,hospitalization and prognosis of the patients were recorded.A multifactorial general logistic regression model was used to analyze the factors influencing the 28 d poor prognosis of ARDS patients,and the predictive value of APACHEII score,PaO_(2)/FiO_(2) and 24 h blood lactate clearance on the risk of poor prognosis within 28d in ARDS patients was assessed by using a subject's work characteristics(ROC)curve.Results Comparison of age,gender,BMI,ARDS etiology,underlying disease,smoking history,white blood cell count,platelet count,and duration of antimicrobial use between the two groups showed no statistically significant difference(P>0.05);Logistics regression analysis showed that risk factors affecting 28-d prognosis of ARDS:A-PACHEⅡ score(P<0.001,OR:1.988,95%CI:1.361-2.904),SOFA score(P<0.001,OR:1.496,95%CI:1.211-1.849),PaO_(2)/FiO_(2)(P<0.001,OR:1.068,95%CI:1.032-1.105),24h blood lactate clearance(P<0.001OR:1.396,95%CI:1.182-1.650)and NLR(P=0.006,OR:1.185,95%CI:0.964-1.457);the differences in APACHEII score,24 h blood lactate clearance and PaO_(2)/FiO_(2) were statistically sig-nificant in the comparison of the two groups(P<0.001),with AUC were 0.878,0.814,and 0.682,respecti

关 键 词：急性呼吸窘迫综合征 APACHEⅡ评分 PaO_(2)/FiO_(2) 24h血乳酸清除率 预后 

分 类 号：R563.8[医药卫生—呼吸系统]