重症急性胰腺炎合并急性呼吸窘迫综合征患者撤机结局预测指标的价值分析  

Predictive values of indicators for withdrawal outcome in patients with severe acute pancreatitis complicated with acute respiratory distress syndrome

作　　者：翁一如 董绉绉[1] 刘盼盼 石林惠[1] 叶恭杰[1] 潘振涛 袁园 WENG Yiru;DONG Zhouzhou;LIU Panpan;SHI Linhui;YE Gongjie;PAN Zhentao;YUAN Yuan(Department of Critical Care Medicine,Ningbo Medical Center Lihuili Hospital,Ningbo 315046,China)

机构地区：[1]宁波市医疗中心李惠利医院重症医学科,315046

出　　处：《浙江医学》2024年第22期2366-2372,2379,共8页Zhejiang Medical Journal

摘　　要：目的探讨氧合指数、呼气末正压通气(PEEP)、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)、血清淀粉酶、CRP对重症急性胰腺炎(SAP)合并急性呼吸窘迫综合征(ARDS)患者撤机结局的预测价值。方法回顾性选取2015年12月至2023年7月宁波市医疗中心李惠利医院东部院区收治的气管插管治疗的84例SAP合并ARDS患者为研究对象,将患者按7∶3的比例随机分为训练集59例和测试集25例。以训练集患者拔除气管插管后48 h内是否再行机械通气作为撤机结局评判标准,采用多因素logistic回归分析训练集中SAP合并ARDS患者撤机失败的影响因素,并采用ROC曲线评估氧合指数、PEEP、APACHEⅡ评分、血清淀粉酶、CRP单一及联合检测对SAP合并ARDS患者撤机失败的预测效能。将多因素logistic回归分析中有统计学意义的影响因素绘制列线图,用列线图对患者撤机失败进行预测以验证其一致性。结果训练集中撤机成功44例,撤机失败15例,撤机成功率为74.6%。与撤机成功组比较,撤机失败组患者APACHEⅡ评分、PEEP、血清淀粉酶、CRP均明显升高,氧合指数明显降低,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,PEEP、APACHEⅡ评分、血清淀粉酶、CRP均是SAP合并ARDS患者撤机失败的独立危险因素(均P<0.05),而氧合指数是独立保护因素(P<0.05)。ROC曲线分析结果显示,氧合指数、PEEP、APACHEⅡ评分、血清淀粉酶、CRP 5个指标联合预测SAP合并ARDS患者撤机失败的AUC为0.982,高于任意单一指标。训练集及测试集校准曲线均显示,实际观察和列线图预测具有良好的一致性。撤机成功组生存率明显高于撤机失败组(P<0.001)。结论PEEP、APACHEⅡ评分、血清淀粉酶、CRP是影响SAP合并ARDS患者撤机结局的独立危险因素,氧合指数则为独立保护因素,上述5个指标联合有较好的预测价值。此外构建的列线图预测模型预测性能佳,能为临�Objective To explore the predictive values of oxygenation index,positive end expiratory pressure(PEEP),Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ),serum amylase,C-reactive protein(CRP)for withdrawal outcome in patients with severe acute pancreatitis(SAP)complicated with acute respiratory distress syndrome(ARDS).Methods A total of 84 patients with SAP complicated with ARDS admitted to the East branch of Ningbo Medical Center.Lihuili Hospital of from December 2015 to July 2023 were retrospectively selected as the study objects,and the patients were randomly assigned to the training set(n=59)and the test set(n=25)according to a ratio of 7∶3.Whether the patients in the training set underwent mechanical ventilation again within 48 h after extubation was used as the evaluation criterion for the withdrawal outcome.Multivariate logistic regression was used to analyze the influencing factors for the withdrawal failure of patients in the training set.Furthermore,ROC curve was used to evaluate the predictive efficacy of oxygenation index,PEEP,combined with APACHEⅡscore,serum amylase and CRP on withdrawal failure.The influencing factors screened out by multivariate logistic regression analysis were used to draw a nomogram,and the nomogram model was used to predict the withdrawal failure of patients to verify its consistency.Results There were 44 successful cases and 15 failed cases,with a successful withdrawal rate of 74.6%.Compared with the successful withdrawal group,APACHEⅡscore,PEEP,serum amylase and CRP in the failed withdrawal group were significantly increased,while oxygenation index was significantly decreased(all P<0.05).Multivariate logistic regression analysis showed that PEEP,APACHEⅡscore,serum amylase and CRP were independent risk factors for withdrawal failure in SAP patients with ARDS(all P<0.05),while oxygenation index was an independent protective factor(P<0.05).ROC curve analysis showed that the AUC of combined prediction of oxygenation index,PEEP,APACHEⅡscore,serum amylase and CR

关 键 词：重症急性胰腺炎 急性呼吸窘迫综合征 撤机 氧合指数 呼吸末正压通气 急性生理学和慢性健康状况评价Ⅱ 血清淀粉酶 C反应蛋白 

分 类 号：R576[医药卫生—消化系统] R563.8[医药卫生—内科学]