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中华肺部疾病杂志(电子版) ›› 2024, Vol. 17 ›› Issue (06) : 942 -947. doi: 10.3877/cma.j.issn.1674-6902.2024.06.016

论著

死腔分数对急性呼吸窘迫综合征预后预测意义
陈丽1, 郭俊氚1, 马红梅1, 刘遵季1,()   
  1. 1.830001 乌鲁木齐,新疆维吾尔自治区人民医院重症医学科
  • 收稿日期:2024-09-13 出版日期:2024-12-25
  • 通信作者: 刘遵季
  • 基金资助:
    新疆维吾尔自治区自然科学基金资助项目(2022D01C600)

Prognostic significance of dead space fraction in acute respiratory distress syndrome

Li Chen1, Juntai Guo1, Hongmei Ma1, Zunji Liu,1()   

  1. 1.Department of Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi, Xinjiang 830001, China
  • Received:2024-09-13 Published:2024-12-25
  • Corresponding author: Zunji Liu
引用本文:

陈丽, 郭俊氚, 马红梅, 刘遵季. 死腔分数对急性呼吸窘迫综合征预后预测意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(06): 942-947.

Li Chen, Juntai Guo, Hongmei Ma, Zunji Liu. Prognostic significance of dead space fraction in acute respiratory distress syndrome[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(06): 942-947.

目的

分析死腔分数(dead cavity score,VD/VT)对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)预后预测意义。

方法

选择2021 年3 月至2024 年3 月我院收治的86 例ARDS患者,院内死亡49 例为观察组,存活37 例为对照组。 入院后第1 天和第3 天记录急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)及呼气终末正压(positive endexpiratory pressure,PEEP)、氧合指数(PaO2/FiO2),院内病死率。 每6 h 进行血气检查,采用Harris-Benedict 公式(VD/VTHB)及生理变量直接估计公式(VD/VTphys)计算VD/VT。 使用限制性三次样条(restricted cubic splines,RCS)分析VD/VTphys、VD/VTHB 与病死率的关联。 绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析预测ARDS 院内预后的曲线下面积(area under the curve,AUC)。

结果

观察组第1 天及第3 天的VD/VTphys(0.56±0.04)、(0.59±0.06),VD/VTHB(0.57±0.07)、(0.59±0.08)高于对照组第1 天及第3 天的VD/VTphys(0.60±0.05)、 (0.63±0.05),VD/VTHB(0.62±0.08)、(0.66±0.08)(P<0.05)。 观察组第3 天VD/VTphys(0.63±0.05)、VD/VTHB(0.66±0.08)较第1 天VD/VTphys(0.60±0.05)、VD/VTHB(0.62±0.08)升高,对照组第3 天VD/VTphys(0.59±0.06)较第1 天VD/VTphys(0.56±0.04)升高。 多因素Logistic 回归分析显示,第3 天VD/VTphys、VD/VTHB 与ARDS 患者院内预后相关(P<0.001)。 RCS 分析显示,第3 天VD/VTphys或VD/VTHB与预后风险为非线性关系,VD/VTHB低于0.58 时,呈负相关。 入院后第3 天APACHEⅡ、PEEP、PaO2/FiO2 为基础加入第3 天VD/VTphys 及VD/VTHB,提升ARDS 院内预后预测(P<0.05)。

结论

计算入院后第3 天的VD/VT 值,VD/VTphys可预测ARDS 院内预后,具有临床意义。

Objective

To analyze the prognostic significance of dead cavity score (VD/VT) in acute respiratory distress syndrome (ARDS).

Methods

A total of 86 ARDS patients admitted to our hospital from March 2021 to March 2024 were selected.49 of them died in hospital in the observation group and 37 survived in the control group.Acute physiological and chronic health score Ⅱ(APACHEⅡ),positive end-expiratory pressure (PEEP) and oxygenation index (PaO2/FiO2) were recorded on the 1st and 3rd day after admission.in-hospital mortality was recorded.Blood gas tests were performed every 6 hours,and VD/VT was calculated using the Harris-Benedict formula (VD/VTHB) and the direct physiological variable estimation formula (VD/VTphys).The association between VD/VTphys,VD/VTHB and mortality was analyzed using restricted cubic splines (RCS).Receiver operating characteristic (ROC) curve was drawn to analyze the area under the curve(AUC) for predicting in-hospital observation in ARDS.

Results

VD/VTphys(0.56±0.04) and (0.59±0.06) on day 1 and day 3 in the death group,VD/VTHB(0.57±0.07),(0.59±0.08) were higher than those of control group (0.60±0.05),(0.63±0.05),VD/VTHB(0.62±0.08),(0.66±0.08) on day 1 and day 3(P<0.05).On day 3,VD/VTphys(0.63±0.05) and VD/VTHB(0.66±0.08) in the observation group were higher than those on day 1,compared with (0.60±0.05) and(0.62±0.08).VD/VTphys on day 3 (0.59±0.06) was higher than that on day 1(0.56±0.04) in control group.Multivariate Logistic regression analysis showed that third dVD/VTphys and VD/VTHB were associated with in-hospital death in ARDS patients (P<0.001).RCS analysis showed that the relationship between VD/VTphys or VD/VTHB and mortality risk at day 3 was non-linear,with a negative correlation when VD/VTHB was below 0.58.After admission,dVD/VTphys and VD/VTHB were added on the basis of dAPACHEⅡ,PEEP and PaO2/FiO2 to improve the predictive value of ARDS hospital death (P<0.05).

Conclusion

Estimation of VD/VT value on the 3rd day after admission can predict the prognosis of ARDS in hospital,which has clinical significance.

表1 两组ARDS 患者临床资料比较[M50(P25,P75),n(%),( ±s)]
表2 两组ARDS 患者APACHEⅡ、呼吸变量、计算VD/VT 分析[M50(P25,P75),( ±s)]
表3 计算VD/VT 与ARDS 院内预后相关性
图1 限制性三次样条曲线判断计算死腔分数与院内预后风险的关系。 注:A:第3 天VD/VTphys;B:第3 天VD/VTHB
表4 计算VD/VT 对ARDS 院内预后预测ROC 曲线分析
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