多种评分系统对体外膜氧合支持下心源性休克患者病死率的预测价值  

Value of different scoring systems in predicting mortality of patients with cardiogenic shock supported by extracorporeal membrane oxygenation

作　　者：卢远波 王晓源[1] 吕光宇 LU Yuanbo;WANG Xiaoyuan;LV Guangyu(Intensive Care Unit,Liuzhou People's Hospital Affiliated to Guangxi Medical University,Liuzhou,Guangxi 545006,P.R.China)

机构地区：[1]广西医科大学附属柳州市人民医院重症医学科,广西柳州545006

出　　处：《中国呼吸与危重监护杂志》2025年第3期192-196,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的 探讨体外膜氧合(extracorporeal membrane oxygenation,ECMO)上机前多评分系统对心源性休克患者病死率的预测价值。方法 回顾性分析2020年7月—2022年7月于广西医科大学附属柳州市人民医院重症医学科因各种原因导致心源性休克并使用静脉-动脉体外膜氧合(veno-arterial ECMO,VA-ECMO)治疗的100例患者,随访30天,根据撤机后30天是否存活分为存活组(35例)和死亡组(65例)。收集患者的一般临床资料、ECMO前24 h内血生化资料、呼吸机参数、既往病史等资料,计算VA-ECMO前序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、VA-ECMO后存活率(survival after veno-arterial ECMO,SAVE)评分及改良SAVE评分。采用两独立样本t检验或Man-Whitney U检验分析筛查与患者预后相关的血生化指标和临床评分,再通过受试者操作特性曲线和曲线下面积(area under curve,AUC)评估各评分对患者短期预后(出院后30天病死率)的预测效能。结果 两组患者APACHEⅡ评分、SAVE评分、改良SAVE评分比较,差异有统计学意义(P<0.05)。两组患者SOFA评分差异无明显统计学意义(P>0.05)。APACHEⅡ评分AUC为0.696[95%置信区间(confidential interval,CI)0.592~0.801],SAVE评分AUC为0.617(95%CI 0.498~0.736),改良SAVE评分AUC为0.664(95%CI 0.545~0.782),但各评分曲线下面积较小(AUC<0.75)。结论 SOFA、APACHEⅡ、SAVE评分及改良SAVE评分对ECMO患者的预后评估临床价值有限,未表现出明显优势。Objective To investigate the predictive value of extracorporeal membrane oxygenation(ECMO)pre-computer multiple scoring systems in the mortality of patients with cardiogenic shock.Methods A retrospective analysis was performed on 100 patients with cardiogenic shock due to various reasons who were treated with veno-arterial ECMO(VA-ECMO) from July 2020 to July 2022.The patients were followed up for 30 days and divided into a survival group(35 cases) and a death group(65 cases) according to whether they survived 30 days after withdrawal.General clinical data,blood biochemistry data within 24 hours before ECMO,ventilator parameters,past medical history and other data were collected,and sequential organ failure score(SOFA) before VA-ECMO,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ),survival after veno-arterial ECMO(SAVE) score and modified SAVE score were calculated.Blood biochemical indicators and clinical scores related to patient prognosis were screened using two-independent sample t test or Man-Whitney U test.The predictive efficacy of each score on short-term prognosis(30-day post-discharge mortality) was evaluated by receiver operating characteristic curve and area under curve(AUC).Results There were significant differences in APACHEⅡ score,SAVE score and modified SAVE score between two groups(P<0.05).The AUC and its 95%CI of APACHEⅡ score was 0.696(95%CI 0.592-0.801),of SAVE score was 0.617(95%CI 0.498-0.736),and of post SAVE score was 0.664(95%CI 0.545-0.782),respectively.All AUCs were relatively low(<0.75).Conclusion SOFA,APACHEⅡ,SAVE score and modified SAVE score have limited clinical value in the prognosis assessment of ECMO patients,and do not show obvious advantages.

关 键 词：体外膜氧合 预后评分 心源性休克 病死率 

分 类 号：R47[医药卫生—护理学]