摘要
目的研究血管外肺水指数(extravascular lung water index,EVLWI)在老年急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者病情及短期预后中的评估预测作用。方法选择莆田学院附属医院重症医学科2020年5月—2022年5月收治的60例老年ARDS患者为观察对象。按照入院后3 d内生存状况分为生存组42例与病死组18例。比较2组各项基线资料[年龄、性别、白细胞(white blood cell,WBC)以及急性生理学及慢性健康状况评分Ⅱ(acute physiology and chronic health evaluation scoring system,APACHEⅡ)等],入院后不同时间点的EVLWI水平、心脏指数(cardiac index,CI)、中心静脉压(central venous pressure,CVP)、平均动脉压(mean artery pressure,MAP)、氧合指数水平。并进行多因素logistic回归分析。结果生存组APACHEⅡ评分低于病死组,差异有统计学意义(P<0.05)。生存组入院后第2、3天时的EVLWI分别为(9.80±2.11)m L/kg、(7.41±1.52)m L/kg,低于病死组的(15.07±2.74)mL/kg、(16.08±2.36)mL/kg,差异有统计学意义(P<0.05)。生存组入院后第2、3天时的CI水平低于病死组,而入院后第2、3天时的氧合指数高于病死组,差异有统计学意义(P<0.05)。以病死为因变量,APACHEⅡ评分、EVLWI、CI、氧合指数为自变量。经多因素logistic回归分析,APACHEⅡ评分、EVLWI、CI均是老年ARDS患者病死的独立危险因素,而氧合指数是老年ARDS患者病死的保护性因素。结论老年ARDS患者入院后随着EVLWI水平的不断升高,患者病死风险随之增加。临床可通过动态监测EVLWI变化趋势,进一步预测患者的病情及短期预后。
Objective To analyze the predictive effect of extravascular lung water index(EVLWI)on the condition and short-term prognosis of elderly patients with acute respiratory distress syndrome(ARDS).Methods A total of 60 elderly patients with ARDS admitted to department of intensive care medicine,the Affiliated Hospital of Putian University from May 2020 to May 2022 were included as for observation.The patients were divided into 42 patients in the survival group and 18 patients in the sick-death group according to their survival status within 3 d after admission.Two groups of the baseline data[mainly include age,gender,the white blood cell(WBC)and acute physiology and chronic health evaluation scoring system(APACHEⅡ)score,etc.],different time points after admission EVLWI levels,cardiac index(CI),central venous pressure(CVP),mean artery pressure(MAP),oxygenation index level were compared.Multivariate logistic regression analysis was performed.Results The survival group of APACHEⅡ score compared with sick-death group was lower,the difference was statistically significant(P<0.05).The EVLWI of the survival group at 2 and 3 d after admission were(9.80±2.11)mL/kg and(7.41±1.52)mL/kg,respectively,which were lower than those of the sick-death group(15.07±2.74)mL/kg and(16.08±2.36)mL/kg,the difference was statistically significant(P<0.05).The survival group had lower CI level at 2 d and 3 d after admission than the sick-death group,while the oxygenation index at 2 d and 3 d after admission was higher than the sick-death group,the difference was statistically significant(P<0.05).In death as the dependent variable,APACHEⅡ score,EVLWI,CI,oxygenation index as the independent variable.The multi-factor logistic regression analysis available,APACHEⅡ score,EVLWI,CI were the independent risk factors of death in patients with ARDS elderly,and oxygenation index was the protective factors of death in patients with ARDS in elderly.Conclusion With the increase of EVLWI level,the risk of death in elderly patients with ARDS increases.We can further predict the patients'condition and short-term prognosis by dynamically monitoring the change trend of EVLWI.
作者
翁春发
胡建雄
李冬平
黄肖海
林美娟
WENG Chunfa;HU Jianxiong;LI Dongping;HUANG Xiaohai;LIN Meijuan(Department of Intensive Care Medicine,the Affiliated Hospital of Putian University,Putian Fujian 351100,China)
出处
《中国卫生标准管理》
2024年第2期117-120,共4页
China Health Standard Management
关键词
急性呼吸窘迫综合征
血管外肺水指数
病情
短期预后
预测作用
老年患者
acute respiratory distress syndrome
extravascular lung water index
patients'condition
short-term prognosis
prediction function
elderly patients
