高龄脓毒性休克患者首次置管时血管外肺水测定与预后

目的探讨高龄脓毒性休克患者首次置管测血管外肺水的特点与疾病预后的判断。方法回顾性分析29例(均>75岁)初次置管行PICCO导管监测高龄脓毒性休克患者,按其28d住院病死率分为存活组和死亡组,对比分析两组患者年龄、性别、感染来源、APACHEⅡ评分、一般血流动力学资料(HR、MAP、CVP、Lac)和EVLWI等数据,并对EVLWI行诊断实验评价。结果两组在APACHEⅡ评分、HR、EVLWI三项差异有统计学意义(P=0.044,0.001,0.007),余则差异均无统计学意义(P>0.05)。描绘EVLWI的ROC曲线发现以≥10.0ml/kg为界点,预测死亡发生的敏感度为94.1%,特异性为66.7%,阳性预测值73.8%,阴性预测值45.9%。结论高龄患者大部分存在肺水肿,且对肺水耐受更差,以EVLWI≥10.0ml/kg是一个较好判断预后不良的指标。

Feature of extravascular lung water index detected initially in elderly patients with septic shock and its influence on prognosis

Objective To investigate the feature of extravascular lung water index detected initially and its influence on prognosis in patients aged >75 years with septic shock.Methods A retrospective analysis of 29 cases of elderly patients(all >75 years) with septic shock first measured by monitoring PICCO was conducted.According to 28-day-hospital mortality,they were divided into the survival group and death group.Between two groups,age,sex,infection sources,APACHEⅡscores,general hemodynamic parameters(HR,MAP,CVP),lactate concentration and initial EVLWI were analyzed by statistics method,and EVLWI were evaluated as prognostic indicators by depicting ROC curve.Results Between two groups,there were statistically significant difference for APACHEⅡ scores,HR,EVLWI(P=0.044,0.001,0.007),and no significant difference for the other(P>0.05).As to EVLWI,ROC curve showed EVLWI≥10.0ml/kg could be as the boundary point,when the sensitivity of predicted deaths was 94.1%,specificity was 66.7%,positive predictive value was 73.8%,negative predictive value was 73.8%,negative predictive value was 45.9%.Conclusion The elderly patients had almost pulmonary edema and had worse tolerance of the lung water than the others,and EVLWI≥10.0ml/kg may serve as a useful index for adverse prognostic outcome.