死腔分数对急性呼吸窘迫综合征预后的评估价值

目的 探讨急性呼吸窘迫综合征(ARDS)患者死腔分数(VD/VT)的动态变化对其预后的评估作用.方法 选择2015年1月至2016年8月昆明医科大学第一附属医院急诊重症监护室(EICU)的ARDS患者32例.按照28 d病死率分为存活组和死亡组.根据公式计算两组患者1～6 d VD/VT.比较两组基础情况、氧合指数(PaO2/FiO2)、急性生理和慢性健康评分(APACHEⅡ)、肺损伤预测评分(LIPS).结果 死亡组和存活组APACHEⅡ和LIPS比较差异有统计学意义(P＜0.05).两组间VD/VT 1～3 d比较差异无统计学意义(P＞0.05),4～6 d死亡组明显高于存活组(P＜0.01).死亡组和存活组动静脉二氧化碳分压差(△PCO2)、PH和PaO2/FiO2比较差异有统计学意义(P＜0.05).经二分类Logistic回归分析,APACHEⅡ、LIPS评分、△PCO2、VD/VT均是危险因素.选4 d VD/VT 0.62为截断值,预后评价的灵敏度90.0％,特异度95.5％.结论 VD/VT为ARDS患者预后的独立危险因素,第4天VD/VT可有效识别高危患者.

Evaluation value of dead-space fraction on prognosis of acute respiratory distress syndrome

Objective To investigate the dynamic changes of dead space fraction (VD/VT) and its effect on the prognosis in the patients with acute respiratory distress syndrome (ARDS).Methods Thirtytwo patients with ARDS in EICU of the First Affiliated Hospital of Kunming Medical University from January 2015 to August 2016 were selected and divided into the survival group and the death group according to the 28 d mortality rate.VD/VT on 1-6 d in the two groups was calculated according to the formula.The parameters of basic condition,PaO2/FiO2,APACHE Ⅱ score,LIPS score,PEEP of the two groups were compared.Results LIPS and APACHE Ⅱ scores had statistical difference between the death group and survival group (P＜0.05);VD/VT on 1-3 d had no statistical difference between the two groups (P＞0.05),and VD/VT on 4-6 d in the death group was significantly higher than that in the survival group (P＜0.01).△PCO2,pH and PaO2/FiO2 had statistical difference between the death group and the survival group (P＜0.05).The binary classification Logistic regression analysis found that APACHE Ⅱ,LIPS,△PCO2,VD/VT were the risk factors.VD/VT on the 4th day was selected,its' cut off value was 0.62,and the sensitivity of the prognostic evaluation was 90.0 ％,the specificity was 95.5 ％.Conclusion The dead space fraction is an independent risk factor for the prognosis of ARDS patients,and VD/VT on 4th day could effectively identify the high-risk patients.