急性肺损伤患者早期肺损伤症状判断对患者行正压通气指导的临床研究

Clinical study of symptoms of early lung injury guidance for positive pressure ventilation patients with early acute lung injury

目的本研究是寻求一系列通过临床经验获得的症状标准,以判定早期急性肺损伤(Early Acute Lung Injury,EALI)患者是否需要进行正压通气治疗。方法收集我院194名可疑急性患者进行前瞻性研究,患者胸片检查双肺均有斑片状阴影并且无左心房压力增高的表现。194名病人中48(24.7%)名患者进展为需要正压通气治疗的急性肺损伤(Acute lung injury,ALI)。与进展为ALI相关的临床变量采用向后回归分析。结果氧需要量、最大呼吸频率及基线免疫抑制被证实是进展为ALI的独立预测因素。EALI评分可较为准确的诊断进展为需要正压通气治疗的ALI病患,受试者工作特征曲线下面积(AUC 0.86)与肺损伤预测评分(Lung Injury Prediction Score,LIPS)接近。EALI评分≥2对进展为需要正压通气治疗的患者的诊断的敏感性为89%,而特异性为75%。从达EALI评分标准到发展为需正压通气治疗的ALI的中位时间为20小时。结论 EALI评分能在正压通气治疗之前早期诊断将要进展为ALI并需要正压通气治疗的患者。

Objective To investigate the need of positive pressure ventilation for patients with early acute lung injury by clinical criteria. Methods We prospectively evaluated 194 patients admitted to our hospital with bi- lateral opacities on chest radiograph without isolated left atrial hypertension. Of the 194 patients enrolled, 48 （24. 7% ） progressed to ALI requiring positive pressure ventilation. Clinical variables associated with progression to ALI were analyzed by backward regression. Results Oxygen requirement, maximal respiratory rate, and baseline immune suppression were independent predictors of progression to ALI. EALI score accurately identified patients who progressed to ALl requiring positive pressure ventilation （ AUC 0. 86） and performed similarly to LIPS （ Lung injury prediction score, LIPS）. An EALI score ≥ 2 identified patients who progressed to ALI with 88% sensitivity and 76% specificity. Median time of progression from EALI criteria to ALI requiring positive pressure ventilation was 20 hours. Conclusion EALI score can early accurately diagnose patients who progress to ALI prior to requiring positive pressure ventilation.