死腔分数对急性呼吸窘迫综合征预后预测意义  

Prognostic significance of dead space fraction in acute respiratory distress syndrome

作　　者：陈丽[1] 郭俊氚 马红梅 刘遵季[1] Chen Li;Guo Juntai;Ma Hongmei;Liu Zunji(Department of Critical Care Medicine,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi,Xinjiang 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院重症医学科,乌鲁木齐830001

出　　处：《中华肺部疾病杂志(电子版)》2024年第6期942-947,共6页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：新疆维吾尔自治区自然科学基金资助项目(2022D01C600)。

摘　　要：目的分析死腔分数(dead cavity score,VD/VT)对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)预后预测意义。方法选择2021年3月至2024年3月我院收治的86例ARDS患者,院内死亡49例为观察组,存活37例为对照组。入院后第1天和第3天记录急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)及呼气终末正压(positive end-expiratory pressure,PEEP)、氧合指数(PaO_(2)/FiO_(2)),院内病死率。每6 h进行血气检查,采用Harris-Benedict公式(VD/VT_(HB))及生理变量直接估计公式(VD/VT_(phys))计算VD/VT。使用限制性三次样条(restricted cubic splines,RCS)分析VD/VT_(phys)、VD/VT_(HB)与病死率的关联。绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析预测ARDS院内预后的曲线下面积(area under the curve,AUC)。结果观察组第1天及第3天的VD/VT_(phys)(0.56±0.04)、(0.59±0.06),VD/VT_(HB)(0.57±0.07)、(0.59±0.08)高于对照组第1天及第3天的VD/VT_(phys)(0.60±0.05)、(0.63±0.05),VD/VT_(HB)(0.62±0.08)、(0.66±0.08)(P<0.05)。观察组第3天VD/VT_(phys)(0.63±0.05)、VD/VT_(HB)(0.66±0.08)较第1天VD/VT_(phys)(0.60±0.05)、VD/VT_(HB)(0.62±0.08)升高,对照组第3天VD/VT_(phys)(0.59±0.06)较第1天VD/VT_(phys)(0.56±0.04)升高。多因素Logistic回归分析显示,第3天VD/VT_(phys)、VD/VT_(HB)与ARDS患者院内预后相关(P<0.001)。RCS分析显示,第3天VD/VT_(phys)或VD/VT_(HB)与预后风险为非线性关系,VD/VT_(HB)低于0.58时,呈负相关。入院后第3天APACHEⅡ、PEEP、PaO_(2)/FiO_(2)为基础加入第3天VD/VT_(phys)及VD/VT_(HB),提升ARDS院内预后预测(P<0.05)。结论计算入院后第3天的VD/VT值,VD/VT_(phys)可预测ARDS院内预后,具有临床意义。Objective To analyze the prognostic significance of dead cavity score(VD/VT)in acute respiratory distress syndrome(ARDS).Methods A total of 86 ARDS patients admitted to our hospital from March 2021 to March 2024 were selected.49 of them died in hospital in the observation group and 37 survived in the control group.Acute physiological and chronic health scoreⅡ(APACHEⅡ),positive end-expiratory pressure(PEEP)and oxygenation index(PaO_(2)/FiO_(2))were recorded on the 1st and 3rd day after admission.in-hospital mortality was recorded.Blood gas tests were performed every 6 hours,and VD/VT was calculated using the Harris-Benedict formula(VD/VT_(HB))and the direct physiological variable estimation formula(VD/VT_(phys)).The association between VD/VT_(phys),VD/VT_(HB) and mortality was analyzed using restricted cubic splines(RCS).Receiver operating characteristic(ROC)curve was drawn to analyze the area under the curve(AUC)for predicting in-hospital observation in ARDS.Results VD/VT_(phys)(0.56±0.04)and(0.59±0.06)on day 1 and day 3 in the death group,VD/VT_(HB)(0.57±0.07),(0.59±0.08)were higher than those of control group(0.60±0.05),(0.63±0.05),VD/VT_(HB)(0.62±0.08),(0.66±0.08)on day 1 and day 3(P<0.05).On day 3,VD/VTphys(0.63±0.05)and VD/VT_(HB)(0.66±0.08)in the observation group were higher than those on day 1,compared with(0.60±0.05)and(0.62±0.08).VD/VT_(phys) on day 3(0.59±0.06)was higher than that on day 1(0.56±0.04)in control group.Multivariate Logistic regression analysis showed that third dVD/VT_(phys) and VD/VT_(HB) were associated with in-hospital death in ARDS patients(P<0.001).RCS analysis showed that the relationship between VD/VT_(phys) or VD/VT_(HB) and mortality risk at day 3 was non-linear,with a negative correlation when VD/VTHB was below 0.58.After admission,dVD/VT_(phys) and VD/VT_(HB) were added on the basis of dAPACHEⅡ,PEEP and PaO_(2)/FiO_(2) to improve the predictive value of ARDS hospital death(P<0.05).Conclusion Estimation of VD/VT value on the 3rd day after admission can predic

关 键 词：急性呼吸窘迫综合征 计算死腔分数 病死率 VD/VT phys VD/VT HB 

分 类 号：R563[医药卫生—呼吸系统]