心肺联合超声对ARDS患者预后的预测价值

目的 分析影响急性呼吸窘迫综合征（ARDS）患者预后的相关因素及重症超声对患者预后的预测价值。方法 回顾性分析在2019年1年~2020年1月期间我院重症监护室收治的ARDS患者124例临床资料。所有患者均进行积极治疗，根据治疗28d内的生存情况，将患者分成生存组和死亡组，分别为66、58例。收集患者入院时的临床资料和入院后的治疗情况。采用多因素Logistic回归分析影响患者预后的相关因素，采用受试者工作特征（ROC）曲线评价重症超声检查对患者预后的预测价值。结果 两组患者在年龄、ARDS类型、ARDS分级、合并休克、APACHEⅡ评分及SOFA评分差异显著（P<0.05）。高龄、ARDS类型（肺内型）、合并休克、APACHEⅡ评分（15~25分）、SOFA评分（>6分）是患者预后的独立危险因素。存活组患者的LUS评分显著低于死亡组，而TAPSE却显著高于死亡组（P<0.05）。两组患者在LVEDD、RVEDD、LVEF、RVEF及TAPSE上差异比较无统计学意义（P>0.05）。LUS、TAPSE及两者联合的曲线下面积分别为0.984、0.900、1.00，最佳临界值分别为14.175分、21.425mm、-1.973，敏感度分别为96.6%、95.5%、100.0%、，特异度分别为92.9%、84.5%、100.0%。结论 高龄、ARDS类型（肺内型）、合并休克、入院时的APACHEⅡ评分（15~25分）、入院时的SOFA评分（>6分）是ARDS患者预后的独立危险因素。入院时LUS、TAPSE对ARDS患者预后具有较高的预测价值，且两者联合检测可以进一步提高预测价值。

The predictive value of combined cardiopulmonary ultrasound in the prognosis of patients with ARDS

Objective To analyze the related factors affecting the prognosis of patients with acute respiratory distress syndrome (ARDS) and the predictive value of severe ultrasound on the prognosis of patients. Methods The clinical data of 124 patients with ARDS admitted to the intensive care unit of our hospital from January 2019 to January 2020 were retrospectively analyzed. All patients underwent active treatment. According to the survival within 28 days of treatment, the patients were divided into survival group and death group, 66 cases and 58 cases respectively. Collect the clinical data of patients on admission and the treatment after admission. Multivariate logistic regression analysis was used to analyze the relevant factors affecting the prognosis of the patients. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of severe ultrasound examination on the prognosis of patients. Results The two groups of patients were significantly different in age, ARDS type, ARDS grade, combined shock, APACHE II score and SOFA score (P<0.05). Old age, ARDS type (intrapulmonary type), combined shock, APACHE II score (15 ~ 25 points), SOFA score (> 6 points) are independent risk factors for patients'' prognosis. The LUS score of the patients in the survival group was significantly lower than that in the death group, while the TAPSE was significantly higher than that in the death group (P<0.05). There was no significant difference in LVEDD, RVEDD, LVEF, RVEF and TAPSE between the two groups of patients (P>0.05). The area under the curve of LUS, TAPSE and the combination of the two is 0.984, 0.900, 1.00, the optimal critical values are 14.175 points, 21.425mm, -1.973, the sensitivity is 96.6%, 95.5%, 100.0%, and specificity, respectively. They are 92.9%, 84.5%, and 100.0%. Conclusion Older age, ARDS type (intrapulmonary type), combined shock, APACHE II score (15-25 points) at admission, and SOFA score (>6 points) at admission are independent risk factors for the prognosis of ARDS patients. At admission, LUS and TAPSE have a high predictive value for the prognosis of ARDS patients, and the joint detection of the two can further improve the predictive value