氧合指数对有创机械通气治疗急性呼吸窘迫综合征患者预后的评估

Value of oxygenation index in assessment of outcome of patients with acute respiratory distress syndrome treated by mechanical ventilator

目的探讨氧合指数对有创机械通气后急性呼吸窘迫综合征（ acute respiratory distress syndrome, ARDS）患者预后的评估价值。方法回顾性分析2008年9月至2013年9月南京医科大学第一附属医院ICU内符合ARDS柏林标准诊断的患者病例资料，包括有创机械通气d0、d1、d3的氧合指数（PaO2／FiO2），比较不同时间点氧合指数与预后的关系。结果236例患者符合ARDS柏林标准的患者人ICU时的APACHEⅡ评分（19．1±3．0），SOFA评分（10．8±2．5）。有创机械通气治疗开始（dO）Pa02／FiO2平均值（150．3±62．6）mmHg（1mmHg=0．133kPa），轻、中、重度ARDS分组，PaO2／FiO2数值分别为（80．1±8．1）、（162．3±19．9）、（261．6±22．3）mmHg，差异具有统计学意义（P〈0．05）。死亡组前3d的氧合指数差异无统计学意义；存活组中d3的氧合指数高于d0，差异具有统计学意义（P〈0．05o入院初APACHElI评分、SOFA评分、d3的氧合指数，对预后影响有统计学意义（P〈0．05）。d3的氧合指数≤180mmHg作为分界点，ROC曲线下面积为0．749，敏感性61．7％，特异性93．2％，与0．5比较差异具有统计学意义（P〈0．05）。结论ARDS患者动态监测氧合指数，对患者早期病情评估有价值；第3天的氧合指数≤180mmHg，往往提示临床预后差。

Objective To determine the value of oxygenation index in assessing the outcome of mechanical ventilated patients with acute respiratory distress syndrome （ARDS）. Methods From September 2008 to September 2013, patients meeting the Berlin definition of ARDS were evaluated in this retrospective study. Data included oxygenation index （PaO2/FiO2 ） on day before, and day 1 and day 3 after mechanical ventilation. The levels of PaO2/FiO2 on day before and day 1 after mechanical ventilation were compared between 28-day survivors and non-survivors. Results There were 236 patients meeting the criteria of the Berlin Definition for diagnosis and treated with mechanical ventilation. The mean score of APACHIE 11 and sequential organ failure assessment （SOFA） at the beginning were （19. 1 ± 3.0 ） and （10. 8 ±2. 5）, respectively, while oxygenation index on day before mechanical ventilation was （150. 3 ± 62. 6） mmHg. According to the hypoxemia grade, patients were divided into mild （ n = 36）, moderate （ n = 122） and severe （ n = 78） ARDS, and their levels of PaO2/FiO2 were （80. 1±8.1 ）, （ 162. 3± 19. 9） and （261.6 ± 22. 3 ） mmHg, respectively. There were 92 non-survivors and 144 survivors. No obvious difference in oxygenation index of non-survivors among on day before, and day 1 and day 3 after mechanical ventilation. There was statistically significant difference in oxygenation index between on day before and day 1 after mechanical ventilation in survivors （ P 〈 0. 05 ）. Compared with the survivors, the score of APACHE Ⅱ , SOFA, and oxygenation index on day 3 were associated with increased mortality in the non-survivors, respectively （ P 〈 0. 05 ）. In respect to the mortality, the cut-off point of score of oxygenation index set at 〈 180 mmHg on Day 3, an area under the receiver operating curve （AUC） was 0. 749 with statisticallysignificance （P 〈 0. 05 ）, leading to sensitivity 61.7% and specificity 93.2%. The relationship between prognosis and antibiotic resistance did not have statistically significance. Conclusions Data of oxygenation index on early phage of ARDS may be valuable to predict the outcome. A strong predictor of adverse outcome in such conditions was the score of oxygenation index on Day 3 -180 mmHg.