氧合指数、功能残气量及最佳呼气末正压水平与ARDS患者机械通气预后的关系和预测价值  

Relationship and predictive value of oxygenation index,functional residual capacity,and optimal positive end-expiratory pressure levels with the prognosis of mechanically ventilation in ARDS patients

作　　者：朱红燕 张莹 刘红红 韩雪娇 ZHU Hong-yan;ZHANG Ying;LIU Hong-hong(Department of Respiratory and Critical Care Medicine,Xingtai Central Hospital,Xingtai Hebei 054000,China)

机构地区：[1]邢台市中心医院呼吸与危重症医学科,河北邢台054000

出　　处：《临床和实验医学杂志》2025年第4期376-380,共5页Journal of Clinical and Experimental Medicine

基　　金：2019年度河北省医学科学研究课题计划(编号:20191677);邢台市科学技术项目(编号:2024ZC211)。

摘　　要：目的探究氧合指数、功能残气量及最佳呼气末正压(PEEP)水平与接受机械通气治疗的急性呼吸窘迫综合征(ARDS)患者预后的关系和预测价值。方法回顾性选取2022年7月至2023年12月邢台市中心医院收治的136例ARDS患者作为研究对象,均接受机械通气,并根据患者住院期间生存情况进行分组:生存组(n=85)和死亡组(n=51)。比较组间临床特征[年龄、性别、合并基础疾病、ARDS病因、机械通气时间、脏器衰竭个数、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、全身性感染相关性器官功能衰竭(SOFA)评分、机械通气即刻心率、机械通气即刻收缩压、机械通气24 h心率、机械通气24 h收缩压]、实验室指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、血乳酸、pH值、血小板计数、总胆红素、尿素氮、血肌酐、脑钠肽]及机械通气24 h呼吸机相关参数(氧合指数、功能残气量、机械能及最佳PEEP水平)情况,并采用受试者操作特征(ROC)曲线探究各指标对患者预后不良的预测价值。结果死亡组患者年龄、机械通气时间、脏器衰竭个数、APACHEⅡ评分、SOFA评分均高于生存组,差异均有统计学意义(P<0.05);组间性别、合并基础疾病(糖尿病、高血压、冠心病、高脂血症)、ARDS病因、机械通气即刻心率、机械通气即刻收缩压、机械通气24 h心率、机械通气24 h收缩压比较,差异均无统计学意义(P>0.05)。生存组和死亡组患者在机械通气即刻组间PaO_(2)、PaCO_(2)、血乳酸、pH值、血小板计数、总胆红素、尿素氮、血肌酐、脑钠肽水平比较,差异均无统计学意义(P>0.05)。死亡组患者在机械通气8、16、24 h时的氧合指数、功能残气量均低于生存组,机械能、最佳PEEP均高于生存组,差异均有统计学意义(P<0.05)。经ROC曲线分析,机械通气8、16、24 h时的氧合指数、功能残气量及机械通气16、24 h时的机械能�Objective To explore the relationship and predictive value of oxygenation index,functional residual capacity and the level of optimal positive end-expiratory pressure(PEEP)with the prognosis of patients with acute respiratory distress syndrome(ARDS)undergoing mechanical ventilation.Methods A total of 136 ARDS patients in Xingtai Central Hospital from July 2022 to December 2023 were retrospectively selected as the research object.All patients received mechanical ventilation and were divided into groups according to their survival status during hospitalization:the survival group(n=85)and the death group(n=51).The clinical characteristics[age,gender,underlying disease,ARDS etiology,duration of mechanical ventilation,number of organ failure,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,systemic infection-related organ failure(SOFA)score,heart rate immediately after mechanical ventilation,systolic blood pressure immediately after mechanical ventilation,heart rate 24 h after mechanical ventilation,systolic blood pressure 24 h after mechanical ventilation],laboratory indexes[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),blood lactate,pH value,platelet count,total bilirubin,urea nitrogen,serum creatinine,brain natriuretic peptide]and parameters related to the ventilator at 24 hours after mechanical ventilation(oxygenation index,functional residual capacity,mechanical energy and the level of PEEP)were compared between the groups.And the predictive value of each index for poor prognosis of patients was explored using the receiver operating characteristic(ROC)curve.Results The age,the duration of mechanical ventilation,the number of organ failures,the APACHEⅡscore and the SOFA score in the death group were higher than those in the survival group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in gender,combined underlying diseases(diabetes,hypertension,coronary heart disease,hyperlipidemi

关 键 词：急性呼吸窘迫综合征 氧合指数 功能残气量 最佳呼气末正压 机械通气 预后 

分 类 号：R563.8[医药卫生—呼吸系统]