超声心动图联合PaO_(2)/FiO_(2)测定在急性肺栓塞病情分层及预后预测中的应用  

Application Value of Echocardiography Combined with PaO_(2)/FiO_(2)in the Stratification and Prognosis Prediction of Acute Pulmonary Embolism

作　　者：熊天波 周小洲 陈瑜莉 王娟 宁燕 Xiong Tianbo;Zhou Xiaozhou;Chen Yuli;Wang Juan;Ning Yan(Department of Ultrasound,Dazu District People'sHospital,Chongqing402360,China;Department of Respiratory and Critical Care Medicine,Dazu District People'sHospital,Chongqing402360,China)

机构地区：[1]重庆市大足区人民医院超声科,重庆市402360 [2]重庆市大足区人民医院呼吸与危重症医学科,重庆市402360

出　　处：《中国超声医学杂志》2024年第11期1237-1241,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的考察超声心动图联合PaO_(2)/FiO_(2)预测急性肺栓塞(APE)病情分层及预后。方法收集APE患者110例并分为低危组30例、中危组50例和高危组30例,根据30 d存活情况分为存活组94例和死亡组16例。收集存在氧合障碍症状但经检测证实健康者50例和慢性肺栓塞患者50例分别为对照1组和对照2组。记录所有受试者的肺栓塞严重指数(PESI)、超声心动图[右心室/左心室横径比(Rv/Lv)、肺动脉收缩压(PASP)]、动脉血氧分压/吸入氧分数比值(PaO_(2)/FiO_(2))。分析APE患者PESI与Rv/Lv、PASP和PaO_(2)/FiO_(2)的相关性,Logistic回归分析影响APE患者预后的因素,使用受试者工作特征(ROC)曲线分析预测APE患者预后的效能。结果与对照1组或对照2组比,APE低危、中危和高危组的血小板、PaO_(2)/FiO_(2)均降低(P<0.05),纤维蛋白原、D-二聚体、C反应蛋白、PESI、PASP、Rv/Lv均增加(P<0.05),PaO_(2)/FiO_(2)呈APE低危、中危和高危组顺序降低趋势,PESI、PASP、Rv/Lv呈升高趋势。PESI与Rv/Lv(r=0.751)、PASP(r=0.423)呈正相关(P<0.05),与PaO_(2)/FiO_(2)(r=0.822)呈负相关(P<0.05)。与存活组比,死亡组的PESI、PASP、Rv/Lv均增加(P<0.05),PaO_(2)/FiO_(2)降低(P<0.05)。PESI与Rv/Lv(r=0.751)、PASP(r=0.423)呈正相关(P<0.05),与PaO_(2)/FiO_(2)(r=0.822)呈负相关(P<0.05)。与存活组比,死亡组的PESI、PASP、Rv/Lv均增加(P<0.05),PaO_(2)/FiO_(2)降低(P<0.05)。PESI、PASP、Rv/Lv、PaO_(2)/FiO_(2)均是影响APE患者预后的因素(P<0.05)。PASP、Rv/Lv、PaO_(2)/FiO_(2)、PASP+Rv/Lv+PaO_(2)/FiO_(2)、PESI在预测APE患者预后的曲线下面积(AUC)>0.70,灵敏度≥62.50%,特异度≥64.90%,PASP+Rv/Lv+PaO_(2)/FiO_(2)在预测APE患者预后的ROC曲线的AUC和特异度均较高。结论超声心动图(PASP、Rv/Lv)联合PaO_(2)/FiO_(2)可用于预测APE病情分层及预后,其效能较PESI高。Objective To investigate the clinical application of echocardiography combined with partial pressure of arterial oxygen/fraction of inspired oxygen(PaO_(2)/FiO_(2))in the disease stratification and prognosis prediction of acute pulmonary embolism(APE).Methods A total of 110 APE patients were collected and divided into 3 groups:APE low-risk group(n=30),APE medium risk group(n=50)and APE high-risk group(n=30).Based on the 30-day follow-up survival status,APE patients were divided into the survival group(n=94)and death group(n=16).Cases with symptoms of oxygenation disorders were collected,including 50 patients who had been tested and confirmed to be healthy and 50 patients with chronic pulmonary embolism,and enrolled into the control group 1 and control group 2,respectively.The pulmonary embolism severity index(PESI),echocardiography[right ventricular/left ventricular aspect ratio(Rv/Lv),pulmonary arterial systolic pressure(PASP)]and partial pressure of arterial oxygen/fraction of inhaled oxygen(PaO_(2)/FiO_(2))of all subjects were collected.The correlation between PESI and Rv/Lv,PASP and PaO_(2)/FiO_(2) in APE patients was analyzed by Pearson correlation,the factors affecting the prognosis of APE patients were analyzed by Logistic regression analysis,and the prognostic efficacy of APE patients was predicted by receiver operating characteristic(ROC)curve analysis Results Compared with the control 1 or control 2 groups,the platelet count,PaO_(2)/FiO_(2) were significantly reduced(P<0.05),fibrinogen,D-dimer,C-reactive protein,PESI,PASP and Rv/Lv were significantly increased in the APE low-risk,medium risk and high-risk group(P<0.05).PaO_(2)/FiO_(2) showed a decreasing trend in the APE low-risk,medium risk,and high-risk groups,while PESI,PASP,and Rv/Lv showed an increasing trend.The PESI was positively correlated with Rv/Lv(r=0.751)and PASP(r=0.423)(P<0.05),negatively correlated with PaO_(2)/FiO_(2)(r=0.822)(P<0.05).Compared with the survival group,the death group had a significant increase in PESI,PASP,Rv/Lv(P<0.05),

关 键 词：超声心动图 动脉血氧分压/吸入氧分数比值 急性肺栓塞 预后 

分 类 号：R540.45[医药卫生—心血管疾病] R563.5[医药卫生—内科学]