肺大泡并发自发性血气胸患者的APACHEⅡ评分、SOFA评分、免疫功能指标的变化及危险因素分析

Changes of acute physiology and chronic health evaluation Ⅱ score, sequential organ failure assessment score,immune function index, and risk factors analysis in patients with pulmonary bullae complicated with spontaneous hemopneumothorax

目的 探讨肺大泡并发自发性血气胸患者的急性生理与慢性健康(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分、免疫功能指标变化及危险因素。方法 回顾性分析2018年8月至2020年8月广东医科大学附属东莞第一医院胸外科收治的82例肺大泡并发自发性血气胸患者的临床资料(观察组),以同期收治的80例肺大泡患者作为对照组。比较两组患者胸闷、气短和呼吸困难的发生情况,同时比较两组患者的住院时间、APACHEⅡ评分、SOFA评分、免疫功能指标和炎症、肺部感染、肺功能障碍的发生率,并采用多因素Logistic回归分析肺大泡并发自发性血气胸的危险因素。结果 观察组患者发生胸闷、气短、呼吸困难的占比分别为76.83%、96.34%、97.56%,明显高于对照组的62.50%、87.50%、81.25%,差异均有统计学意义(P<0.05);观察组患者的住院时间为(11.20±1.48) d,明显长于对照组的(4.83±1.05) d,APACHEⅡ、SOFA评分分别为(21.18±3.55)分、(8.82±1.24)分,明显高于对照组的(18.70±5.08)分、(6.90±1.08)分,炎症、肺部感染、肺功能障碍的发生率分别为30.49%、60.98%、58.54%,明显高于对照组的13.75%、43.75%、37.50%,差异均有统计学意义(P<0.05);观察组患者的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平分别为(50.37±4.30)%、(20.20±2.06)%、(18.82±2.36)%、0.79±0.17,明显低于对照组的(62.52±7.22)%、(32.69±6.03)%、(26.47±3.05)%、1.60±0.24,差异均有统计学意义(P<0.05);经Logistic回归性分析结果显示,APACHEⅡ评分、SOFA评分、炎症、肺部感染、肺功能障碍均是肺大泡并发自发性血气胸的危险因素(P<0.05)。结论 肺大泡并发自发性血气胸患者的临床特点为胸闷、气短、呼吸困难,APACHEⅡ评分、SOFA评分、炎症、肺部感染、肺功能障碍均是影响肺大泡并发自发性血气胸的危险因素,在临床实践中应对这些高危患者进行监测和重视。

Objective To study the changes of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, sequential organ failure assessment(SOFA) score, immune function index, and risk factors in patients with pulmonary bullae complicated with spontaneous hemopneumothorax. Methods The clinical data of 82 patients with pulmonary bullae complicated with spontaneous hemopneumothorax admitted to the Department of Thoracic Surgery,the First Dongguan Affiliated Hospital of Guangdong Medical University from August 2018 to August 2020 were retrospectively analyzed(observation group), and 80 patients with pulmonary bullae admitted in the same period were used as the control group. The incidence of chest tightness, shortness of breath and dyspnea were compared between the two groups, and the length of hospital stay, mechanical ventilation duration, APACHEⅡ score, SOFA score, immune function index, incidence of inflammation, pulmonary infection, and pulmonary dysfunction were compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors of pulmonary bullae complicated with spontaneous pneumothorax. Results The proportions of chest tightness, shortness of breath, and dyspnea in the observation group were 76.83%, 96.34%, and 97.56%, which were significantly higher than 62.50%, 87.50%, and 81.25% in the control group(P<0.05). The length of hospital stay in the observation group was(11.20±1.48) d, which were significantly longer than(4.83±1.05) d in the control group, the APACHEⅡ and SOFA scores were(21.18±3.55) points and(8.82±1.24) points, which were significantly higher than(18.70±5.08) points and(6.90±1.08) points in the control group, and the incidences of inflammation, lung infection, and pulmonary dysfunction were 30.49%, 60.98%, 58.54%,significantly higher than 13.75%, 43.75%, and 37.50% in the control group(P<0.05). The levels of CD3^(+), CD4^(+), CD8^(+),CD4^(+)/CD8^(+)in the observation group were(50.37±4.30)%,(20.20±2.06)%,(18.82±2.36)%, 0.79±0.17, which were significantly lower than(62.52±7.22)%,(32.69±6.03)%,(26.47±3.05)%, 1.60±0.24 in the control group(P<0.05). Logistic regression analysis showed that APACHEⅡ score, SOFA score, inflammation, pulmonary infection and pulmonary dysfunction were all risk factors for pulmonary bullae complicated with spontaneous hematomthorax(P<0.05). Conclusion The clinical characteristics of patients with pulmonary bullae complicated with spontaneous hematomthorax are chest tightness, shortness of breath and dyspnea. APACHEⅡ score, SOFA score, inflammation, pulmonary infection, and pulmonary dysfunction are all risk factors affecting pulmonary bullae complicated with spontaneous hematomthorax. These high-risk patients should be monitored and paid attention to in clinical practice.