ARDS患者肺泡动脉氧分压差与死腔分数检测在病情判断和短期预后评估中的应用价值

目的　研究急性呼吸窘迫综合征（ARDS）患者肺泡动脉氧分压差P(A-a)O2]和死腔分数（VD/VT）在病情判断和短期预后评估中的应用价值。方法　收集2018年7月～2020年7月咸阳市第一人民医院84例急诊ARDS患者作为研究对象，根据ARDS病情将84例患者分为A组（轻度，28例），B组（中度，30例）及C组（重度，26例）。比较三组急诊患者入院后P(A-a)O2]和VD/VT水平，记录28天病死率，分析P(A-a)O2]和VD/VT判断急诊ARDS病情程度和死亡风险的价值。结果　A，B，C三组VD/VT水平依次为0.49±0.07，0.54±0.10，0.59±0.08；P（A-a）O2（mmHg）水平依次为160.67±56.32，234.45±80.98，348.29±135.74。C组患者VD/VT和P(A-a)O2水平显著高于A,B两组，B组VD/VT和P(A-a)O2水平显著高于A组，差异均有统计学意义（F=9.381，26.389，均P<0.05）。84例患者中死亡28例，28天病死率为33.33%。P(A-a)O2判断重度ARDS的AUC为0.794（SE=0.071，95%=0.655～0.934），敏感度和特异度分别为0.769和0.690。入院4天时VD/VT预测ARDS死亡的AUC为0.824（SE=0.066，95%=0.694～0.953），敏感度和特异度分别为0.857和0.607。结论　P(A-a)O2, VD/VT与急诊ARDS病情程度和28天病死率相关，P(A-a)O2有助于判断病情程度，而入院4天时VD/VT水平对预测ARDS死亡准确性较高。

Application Value of Difference of Alveolar Arterial Oxygen Partial Pressure and Dead Volume Ratio in the ARDS Patients to Judge Disease Condition and Short-Term Prognosis Assessment

Objective To study the application value of pulmonary alveolar arterial oxygen partial pressureP(A-a)O₂]and dead space fraction(VD/VT)in patients with acute respiratory distress syndrome(ARDS).Methods 84 emergency ARDS patients from July 2018 to July 2020 in the Department of Internal Medicine of the First People’s Hospital of Xianyang were collected as the research objects,and the 84 patients were divided into group A(mild,28 cases),group B(moderate,30 cases)and group C(severe,26 cases),which accorded to the condition of ARDS.The levels of P(A-a)O₂]and VD/VT after admission of the three groups in emergency patients were compared.The 28 days case fatality rate was recorded.The value of P(A-a)O₂ and VD/VT to judge the severity of emergency ARDS and the risk of death were analyzed.Results The levels of VD/VT and P(A-a)O₂(mmHg)in group A,B,C were 0.49±0.07,0.54±0.10,0.59±0.08 and 160.67±56.32,234.45±80.98,348.29±135.74.The levels of VD/VT and P(A-a)O₂ in group C were significantly higher than those in groups A and B,the levels of VD/VT and P(A-a)O₂ in group B were significantly higher than those in group A,and the difference were statistically significant(F=9.381,26.389,all P<0.05).There were 28 died among the 84 patients,and the 28-day fatality rate was 33.33%.The AUC of P(A-a)O₂ to judge the severe ARDS was 0.794(SE=0.071,95%=0.655~0.934),the sensitivity and specificity were 0.769 and 0.690,respectively.The AUC of VD/VT to predict the ARDS death at the 4th day of admission was 0.824(SE=0.066,95%=0.694~0.953),the sensitivity and specificity were 0.857 and 0.607 respectively.Conclusion The P(A-a)O₂ and VD/VT were related to the severity of emergency ARDS and the 28-day mortality rate.The P(A-a)O₂ can help determine the severity of the disease,and the VD/VT level at the 4th day of admission is more accurate in predicting ARDS death.