老年呼吸衰竭合并脓毒性休克患者血管外肺水指数的特点及其对死亡的预测价值

Study on the signficance of characterisitics of extravascular lung water index and the predictive value of death in elderly patients with respiratory failure conmplicated with septic shock

目的分析血管外肺水指数(EVLWI)在老年呼吸衰竭合并脓毒性休克患者中的特点及其对死亡的预测价值。方法收集呼吸衰竭合并脓毒性休克的老年患者共62例,根据病情程度分为轻度组、中度组、重度组,根据临床结局分为死亡组和存活组。检测患者心率(HR)、全心射血分数(GEF)、中心静脉压(CVP)、平均动脉压(MAP)、氧合指数(OI)、肺血管通透性指数(PVPI)、血管外肺水指数、动脉血乳酸浓度,评估急性生理与慢性健康评分Ⅱ(APACHEⅡ)。根据预后ROC曲线分析EVLWI对该类患者预后的预测价值。结果重度患者乳酸浓度、OI、EVLWI、PVPI均与中度及轻度患者有显著差异;轻度组、中度组、重度组死亡率分别为25.00%、54.17%、66.68%;死亡组EVLWI、乳酸浓度、APACHEⅡ评分、PVPI及OI与存活组比较,差异均有统计学意义(P<0.05)。以EVLEI≥10.0 ml/kg为截点,EV-LEI预测死亡的灵敏度、特异度分别为67.42%、90.54%;阴性预测值、阳性预测值分别为80.07%、84.20%。结论①老年呼吸衰竭合并脓毒性休克患者病情越重则乳酸浓度、OI、EVLWI、PVPI越偏离正常水平;②EVLWI≥10.0ml/kg为临界点对老年呼吸衰竭合并脓毒性休克患者的预后有较高的预测价值。

Objective To analyze the significance of characterisitics of extravascular lung water index（EVLWI） in elderly patients with respiratory failure complicated with septic shock and its positive predictive value of death.Methods A total of 62 elderly patients with respiratory failure complicated with septic shock,they were divided into mild group,moderate group and severe group according to their severity,and they were further divided into death group and survival group according to their clinical outcomes.Detection of heart rate（HR）,heart ejection fraction（GEF）,central venous pressure（CVP）,mean arterial pressure（MAP）,oxygenation index（OI）,pulmonary vascular permeability index（PVPI）,extravascular lung water index and blood concentration of lactate were applied for assessment of acute physiology and chronic health evaluationⅡ（APACHE Ⅱ）.The prognostic value EVLWI in this class of patients was predicted according to the analysis of ROC curve.Results The concentration of lactic acid,OI,EVLWI and PVPI in severe patients had obvious difference with moderate and mild patients.The mortality rates of mild,moderate and severe patients were 25.00%,54.17%and 66.68%respectively.The difference in EVLWI,concentration of lactic acid,APACHE Ⅱ scores,PVPI and OI in survival group in comparison with those of death group had statistical significance.（P 〈0.05）.The selection of EVLEI acuity 10.0 ml/kg as the cut- off point.The degrees of sensitivity and specificity of EVLET in prediction of death were 67.42%and 90.54%respectively;and its negative predictive value and positive predictive value were 80.07%and 84.20%respectively.Conclusion① In senile patients with respiratory failure complicated with septic shock,the more severe the patients condition is,the deviation of lactic acid concentration,OI,EVLWI and PVPI from the normal level will be;②EVLWI≥10.0 ml / kg as the critical point has higher prognostic value.