氧合指数与APACHEⅢ评分对肝移植手术后急性呼吸窘迫综合征患者预后影响的比较研究

Comparison of the assessment of oxygenation index and APACHE Ⅲ on the prognosis of ARDS patients underwent orthotopic liver transplantation

目的比较氧合指数和APACHEⅢ评分对肝移植手术后急性呼吸窘迫综合征(ARDS)患者预后影响及其相关性。方法收集我院62例肝移植手术后ARDS病例,计算其确诊时、确诊后第3天、第5天的氧合指数和慢性健康状况评分(APACHEⅢ),比较死亡组和存活组的差异并分析它们与患者临床预后的关系。结果氧合指数:死亡组和存活组在确诊时无统计学差异,存活组随治疗改善明显,有统计学差异(P<0.05);死亡组虽有改善,但无统计学差异。APACHEⅢ评分:死亡组和存活组在各个时间点均有统计学差异(P<0.05)。死亡组随时间推移而显著上升;存活组随时间推移显著下降。结论氧合指数只能反映肝移植术后ARDS患者肺内情况,可作为诊断指标,评估总体危重程度不全面,单独判断预后不可靠;APACHEⅢ评分与病情危重程度相关,连续评价APACHEⅢ评分对判断总体病情严重程度、制订治疗策略和预测预后是十分重要的。

Objective To compare the effects of oxygenation index（OI）and APACHEⅢ with the prognosis of ARDS patients underwent orthotopic liver transplantation.Methods 62 cases of ARDS patients underwent orthotopic liver transplantation were collected and analyzed.Patients were divided into survival and death group according to the clinical results.OI and APACHEⅢwere compared in each group and between groups,and the effect of each on the clinical prognosis was evaluated and compared.Results OI：there was no difference between two groups（P0.05）when diagnosed.After treatments,OI in survival group improve significantly（P0.05）.It improved too,but there was no significant difference in death group.APACHEⅢ：there were significant differences at every time point in each group and between two groups.Conclusions OI fails to predict the prognosis of ARDS after liver transplantation.APACHEⅢ can provide an accurate prognosis assessment of ARDS after liver transplantation.Dynamic monitoring of APACHEⅢ score will help to evaluate the prognosis and change/adopt some treatments.