APACHEⅡ评分、动脉血乳酸、氧合指数、CRP、D-二聚体等指标对重症肺炎预后的价值

Relationship between Severe Pneumonia Prognosis and APACHE Ⅱ,Lac,Oxygenation Index,CRP,and D-dimer

目的探讨急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、动脉血乳酸(Lac)、氧合指数、C反应蛋白(CRP)以及D-二聚体预测对重症肺炎患者预后的价值。方法选择2012年1月至2014年12月入住岳池县人民医院ICU病房的106例重症肺炎患者,根据患者预后情况分为存活组(51例)和死亡组(55例),测定两组患者入住ICU后APACHEⅡ、Lac、氧和指数、CRP以及D-二聚体等指标水平,分析上述指标与患者预后的关系。结果入ICU时,死亡组患者的年龄高于存活组,差异有统计学意义(P<0.05);存活组患者与死亡组患者重症社区获得性肺炎(SCAP)和重症医院获得性肺炎(SCAP)比例、机械通气比例以及合并基础疾病种类比较差异也有统计学意义(P<0.05);两组患者的APACHEⅡ、氧和指数、Lac、CRP以及D-二聚体比较差异均有统计学意义[(20.3±4.2)比(27.5±5.1);(278.1±25.3)比(257.4±29.0);(3.3±1.1)mmol/L比(4.3±1.3)mmol/L;(72.0±28.9)mg/L比(105.5±32.7)mg/L;(3.5±1.2)mg/L比(5.2±2.1)mg/L](P<0.01);死亡组中APACHEⅡ>30分(69.2%)、氧合指数<250(68.4%)、Lac>4 mmol/L(69.1%)、CRP≥100mg/L(74.4%)以及D-二聚体≥5.0 mg/L(73.2%)的患者所占的比例均高于存活组[分别为(30.8%、31.6%、30.9%、25.6%以及26.8%)],比较差异均有统计学意义(P<0.05)。结论APACHEⅡ、氧和指数、Lac、C反应蛋白及D-二聚体与重症肺炎患者的预后密切相关,超越临界值患者的死亡风险较高,临床在诊疗时应密切注意。

Objective To investigate the prognostic value of acute physiology and chronic health evaluation scoring II （ APACHE II ） score, oxygenation index （ PaO2/FiO2 ）, arterial blood lactic acid （ Lae ）, C-reactive protein（CRP） and D-dimer for severe pneumonia. Methods The clinical data of 106 cases of severe pneumonia in Yuechi People＇s Hospital from Jan. 2012 to Dee. 2014 were retrospectively analyzed. According to the prognosis,they were divided into survival group and death group,APACHE II score,Lac, PaO2/FiO2, CRP and D-dimer of the two groups after admission to ICU were tested and stratified, the rela-tionship of the five indexes with the prognosis were analyzed. Results At admission to ICU, the age of the death group was higher than the survival group, the difference was statistically significant （ P 〈 0. 05 ） ; the proportion of severe community acquired pneumonia （SCAP） and severe hospital acquired pneumonia （SHAP） ,cases of mechanical ventilation and combined basic diseases of the survival group and death group were statistically significantly different （ P 〈 0. 05 ）. APACHE I] [ （ 20. 3 ± 4. 2） vs （ 27. 5 ± 5. 1 ） ], the oxygen index[ （278. 1 ± 25.3 ） vs （257.4 ± 29.0 ） ], Lac [ （3.3 ± 1.1 ） mmol/L vs （4. 3 ± 1.3 ） mmol/ L] ,CRP [ （72.0 ±28.9）mg/L ys （105.5 ±32： 7）mg/L] and D-dimer[ （3.5 ±1.2） mg/L vs （5.2 ± 2. 1 ） mg/L] of the two groups were statistically significantly different （ P 〈 0. 01 ）. In the death group, the percentage of patients with APACHE II 〉 30 （ 69： 2% ）, oxygen index 〈 250 （ 68.4% ）, Lac 〉 4 mmol/L （69. 1% ） ,CRP ±100 mg/L（74. 4% ） and D-dimer ≥5.0 mg/L（73.2% ） were higher than that in the survival goup （30. 8% ,31.6% ,30. 9% ,25.6% and 26. 8% ） ,the differences had statistical significance （P 〈 0. 05）. Conclusion APACHE II score, oxygen index, Lac, CRP and D-dimer are closely related to the prognosis of severe pneumonia, patients with the indexes beyond the critical value have higher risk of death, and close attention should be paid to the diagnosis and treatment in clinical.