不同时间点血乳酸联合肺部超声评分对慢性阻塞性肺疾病急性加重期撤机失败的预测分析  

Prediction analysis of blood lactic acid combined with pulmonary ultrasound score at different time points on withdrawal failure in acute exacerbation of chronic obstructive pulmonary disease

作　　者：李蓉[1] 龙瀛[1] Li Rong;Long Ying(Respiratory Center WardⅠ,Suining Central Hospital,Suining 629000,China)

机构地区：[1]四川省遂宁市中心医院呼吸中心一病区,629000

出　　处：《临床内科杂志》2025年第2期122-126,共5页Journal of Clinical Internal Medicine

摘　　要：目的探讨不同时间点血乳酸(Lac)水平联合肺部超声评分对慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)撤机失败的预测价值。方法根据是否撤机失败将168例AECOPD患者分为撤机失败组(41例)和撤机成功组(127例),收集其一般临床资料、治疗前后动脉氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))、急性生理学与慢性健康状况(APACHEⅡ)评分、血乳酸(Lac)及肺部超声评分并进行组间比较。采用多因素logistic回归分析评估撤机失败的危险因素。采用受试者工作特征(ROC)曲线评估不同时间点Lac、肺部超声评分对撤机失败的预测价值。结果撤机失败发生率为24.40%(41/168)。撤机失败组有吸烟史、合并高血压、合并多器官功能障碍综合征(MODS)患者比例及COPD病程、通气时间均高于撤机成功组(P<0.05)。治疗前,撤机失败组患者PaO_(2)及SaO_(2)均低于撤机成功组,PaCO_(2)、APACHEⅡ评分、Lac及肺超部声评分均高于撤机成功组;治疗后24 h及48 h,撤机失败组APACHEⅡ评分、Lac及肺部超声评分均高于同期撤机成功组(P<0.05)。两组患者治疗前、治疗后24 h及48 h,PaO_(2)、SaO_(2)均升依次升高,PaCO_(2)均依次下降;撤机成功组患者治疗前、治疗后24 h及48 h APACHEⅡ评分、Lac及肺部超声评分均依次下降;撤机失败组治疗后48 h APACHEⅡ评分低于同组治疗后24 h(P<0.05)。多因素logistic回归分析结果显示,合并高血压、合并MODS、治疗前及治疗后24 h和48 h Lac及肺部超声评分升高均是撤机失败的危险因素(P<0.05)。倾向性评分匹配后撤机失败组治疗前及治疗后24 h、48 h的Lac及肺部超声评分均高于同期撤机成功组(P<0.05)。ROC曲线分析结果显示,不同时间点联合预测撤机失败的敏感度和曲线下面积(AUC)均高于各时间点各指标单独预测,治疗后48 h Lac联合肺部超声评分预测撤机失败的价值最高(P<0.001)。结论AECOPD患者治Objective To investigate the predictive value of blood lactate(Lac)level combined with pulmonary ultrasound score at different time points for withdrawal failure in acute exacerbation of chronic obstructive pulmonary disease(COPD,AECOPD).Methods A total of 168 AECOPD patients were divided into failure group(41 cases)and successful group(127 cases)according to whether the patients failed to withdraw.General clinical data,arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),blood oxygen saturation(SaO_(2)),acute physiology and chronic health status(APACHEⅡ)scores,blood lactic acid(Lac)and pulmonary ultrasound scores were collected and compared between groups.Multivariate logistic regression analysis was used to evaluate the risk factors of machine withdrawal failure.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of Lac and pulmonary ultrasound scores at different time points for withdrawal failure.Results The dropout failure rate was 24.40%(41/168).The proportion of patients with smoking history,hypertension,multiple organ dysfunction syndrome(MODS)and COPD course,ventilation time in failed group were higher than those in successful group(P<0.05).Before treatment,PaO_(2) and SaO_(2) in failed group were lower than those in successful group,and PaCO_(2),APACHEⅡscores,Lac and pulmonary ultrasound scores were higher than those in successful group;after treatment at 24 h and 48 h,APACHEⅡscores,Lac and pulmonary ultrasound scores in failed group were higher than those in successful group(P<0.05).Before and after treatment at 24 h and 48 h,PaO_(2) and SaO_(2) were increased successively,while PaCO_(2) were decreased successively in two groups;The APACHEⅡscores,Lac and pulmonary ultrasound scores were decreased successively before and after treatment at 24 h and 48 h in successful group;The APACHEⅡscore in failed group after treatment at 48 h was lower than after treatment at 24 h in the same group(P<0.05).Multivariate logistic

关 键 词：血乳酸 床旁肺部超声检查 慢性阻塞性肺疾病 机械通气 撤机失败 

分 类 号：R563.9[医药卫生—呼吸系统] R459.7[医药卫生—内科学] R459.9[医药卫生—临床医学]