摘要
目的 探讨急性生理与慢性健康评分(APACHEⅡ评分)、氧合指数(PaO2/FiO2)与24h血乳酸清除率对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者病情预后评估效能.方法 采用回顾性研究分析方法,收集2022年9月至2023年11月在内蒙古自治区人民医院重症医学科住院治疗的76例ARDS患者的临床资料,根据28 d临床结局将其分为生存组(43例)和死亡组(33例).比较两组的一般资料、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血乳酸(Lactate,Lac)、24 h血乳酸清除率、PaO2/FiO2、序贯器官衰竭评分(SOFA评分)和APACHEⅡ评分.记录患者机械通气时间、住院时间及预后.采用多因素一般Logistic回归模型分析ARDS患者28 d内预后不良的影响因素,采用受试者工作特征(ROC)曲线评估APACHEⅡ评分、PaO2/FiO2及24 h血乳酸清除对ARDS患者28 d内不良预后风险的预测价值.结果 两组的年龄、性别、身体质量指数(BMI)、ARDS病因、基础疾病、吸烟史、白细胞计数、血小板计数、抗菌药物使用时间比较,差异无统计学意义(P＞0.05);Logistics回归分析结果显示影响ARDS 28 d 内预后的危险因素为 APACHEⅡ 评分(P＜0.001,OR:1.988,95％CI:1.361～2.904)、SOFA 评分(P＜0.001,OR:1.496,95％CI:1.211～1.849)、PaO2/FiO2(P＜0.001,OR:1.068,95％CI:1.032～1.105)、24 h 血乳酸清除(P＜0.001,OR:1.396,95％CI:1.182～1.650)及 NLR(P=0.006,OR:1.185,95％CI:0.964～1.457);两组APACHEⅡ评分、24 h血乳酸清除及PaO2/FiO2比较,差异具有统计学意义(P＜0.001),其 AUC 分别为 0.878、0.814、0.682,敏感度为 84.80％、81.80％、42.40％,特异度为 76.74％、65.12％、95.35％;阳性预测值为 73.68％、58.18％、87.50％,阴性预测值为 86.84％、95.24％、69.49％,3者联合预测的AUC为0.963、敏感度为97％、特异度为95.35％.结论 APACHEⅡ评分、PaO2/FiO2增高及24 h血乳酸清除率降低均可增加ARDS患者病情预后不良风险,且均对ARDS患者不良预后具有一定的预测效能,但上述3者联合价值更高,因此适合进一步研究和普及.
Abstract
Objective To investigate the efficacy of APACHEⅡ score,PaO2/FiO2 and 24 h blood lactate clearance on the prognosis of patients with acute respiratory distress syndrome(ARDS).Methods A retrospec-tive study was conducted to collect the clinical data of 76 patients with ARDS who were hospitalized in the De-partment of Intensive Care Medicine of the Inner Mongolia Autonomous Region People's Hospital from Septem-ber 2022 to November 2023,and the patients were classified into 43 survivors and 33 deaths according to the clinical outcomes in the 28-d period.The general data,neutrophil to lymphocyte ratio(NLR),blood lactate(Lactate,Lac),24 h blood lactate clearance,oxygenation index(PaO2/FiO2),sequential organ failure score(SOFA score),and acute physiologic and chronic health score(APACHEⅡ score).The duration of mechanical ventilation,hospitalization and prognosis of the patients were recorded.A multifactorial general logistic regres-sion model was used to analyze the factors influencing the 28 d poor prognosis of ARDS patients,and the predic-tive value of APACHEⅡ score,PaO2/FiO2 and 24 h blood lactate clearance on the risk of poor prognosis within 28d in ARDS patients was assessed by using a subject's work characteristics(ROC)curve.Results Comparison of age,gender,BMI,ARDS etiology,underlying disease,smoking history,white blood cell count,platelet count,and duration of antimicrobial use between the two groups showed no statistically significant difference(P＞0.05);Logistics regression analysis showed that risk factors affecting 28-d prognosis of ARDS:A-PACHEⅡ score(P＜0.001,OR:1.988,95％CI:1.361-2.904),SOFA score(P＜0.001,OR:1.496,95％CI:1.211-1.849),PaO2/FiO2(P＜0.001,OR:1.068,95％CI:1.032-1.105),24h blood lactate clearance(P＜0.001 OR:1.396,95％CI:1.182-1.650)and NLR(P=0.006,OR:1.185,95％CI:0.964-1.457);the differences in APACHEⅡ score,24 h blood lactate clearance and PaO2/FiO2 were statistically sig-nificant in the comparison of the two groups(P＜0.001),with AUC were 0.878,0.814,and 0.682,respec-tively,with sensitivities of 84.80％,81.80％,and 42.40％,and specificities of 76.74％,65.12％,and 95.35％,respectively;The positive predictive values were 73.68％,58.18％,and 87.50％,and the negative predictive values were 86.84％,95.24％,and 69.49％,respectively.The combined prediction of the three had an AUC of 0.963,a sensitivity of 97％,and a specificity of 95.35％.Conclusion APACHEⅡ score,increased PaO2/FiO2 and decreased 24h blood lactate clearance can increase the risk of poor prognosis in ARDS patients,and all have certain predictive efficacy for poor prognosis in ARDS patients,but the combined value of the above three is much higher,so it is suitable for further research and popularization.
基金项目
内蒙古医科大学联合项目(YKD2022LH015)
内蒙古自治区自然科学基金(2023MS08019)
内蒙古自治区卫生健康科技计划项目(202201011)
内蒙古自治区公立医院科研联合基金科技项目(2023GLLH0012)
内蒙古自治区人民医院院内基金(2020YN06)
内蒙古自治区人民医院博士科研启动基金(2020BS06)
NETL
NSTL
万方数据