日常生活能力量表对AECOPD患者机械通气治疗结局的预测价值

Predictive value of ADL score in AECOPD patients requiring invasive mechanical ventilation

目的:对于慢性阻塞性肺疾病急性加重(AECOPD)伴呼吸衰竭接受有创呼吸支持治疗的患者,目前临床上尚缺乏有效可行的生活质量评分系统来预测撤机结果。本研究尝试采用非特异的日常生活能力(ADL)评定量表Barthel指数来预测此类患者的治疗转归。方法:前瞻性分析25例行有创机械通气的AECOPD患者,统计入院时的动脉血气分析、炎症指标、血糖、心衰指数、营养状况和APPACHEⅡ评分等指标以及患者近期稳定状态时ADL评分,根据撤机结果分为撤机成功组(12例)和撤机失败组(13例),统计2组各项指标的差异。再根据ADL评分,将25例患者分为ADL>60分组(13例)和ADL≤60分组(12例),比较2组撤机成功率和6个月病死率。结果:撤机成功组与撤机失败组间仅ADL评分差异有统计学意义(93.46±5.16vs.52.08±16.71,P=0.022),其余各项指标差异均无统计学意义。ADL>60分组和ADL≤60分组的撤机成功率比较差异有统计学意义(84.6%vs.8.3%,P<0.0001),6个月病死率比较差异有统计学意义(23.1%vs.100.0%,P<0.0001)。结论:本次预实验的研究结果表明ADL评分对AECOPD机械通气的治疗结局有较好的预测价值。

Objective：There is limited effective and feasible life quality assessment systems available to predict the outcomes of patients with AECOPD suffering from acute respiratory failure（ARF）accepted invasive mechanical ventilation（MV）.This study attempted to use the activities daily living（ADL）score to predict the outcome of this kind of patients.Method：A total of 25 AECOPD patients with ARF admitted to intensive care unit（ICU）were enrolled in this prospectively study.They were divided into successful weaning group（12patients）and unsuccessful weaning group（13patients）.On admission of their hospitalization,the clinical information including arterial blood gases,nutritional status,inflammatory biomarkers,blood glucoses,BNP,ADL scores,and APPACHEⅡ scores were collected and analyzed.According to the ADL score,the patients were divided into ADL score60group（13patients）and ADL score≤60group（12patients）.The success rate of weaning and the mortality at the6 th month were investigated.Result：The ADL score was higher in successful weaning group than that in unsuccessful weaning group（93.46±5.16 vs.52.08±16.71,P=0.022）.Weaning was achieved in 84.6% of the cases with an ADL score60and in 8.3% of the cases with an ADL score≤60（P〈0.0001）.Arterial blood gases,inflammatory biomarkers,BNP and nutritional status were similar in both groups.The mortality at the sixth month was 23.1%in the cases with an ADL score60and was 100%in the cases with an ADL score≤60（P〈0.0001）.Conclusion：Our pilot study indicated that the ADL score may predict weaning and 6month survival in AECOPD patients with ARF accepted invasive MV treatment.