改良肺超声失充气评分对重症医学科内休克患者预后的价值

Prognostic value of modified lung ultrasound aeration loss score in shock patient in intensive care unit

目的探讨改良的肺超声失充气评分（mLUS）对重症医学科（ICU）内休克患者预后的价值。方法前瞻性研究，纳入2016年4至8月四川大学华西医院ICU休克患者90例，在休克6 h内进行床旁重症心肺超声检查，采集mLUS等超声指标及临床指标，随访患者结局。统计分析mLUS等指标与ICU内休克患者住院病死率的相关性，检验其对ICU内休克患者预后的预测价值。结果死亡组和生存组相比年龄、急性生理与慢性健康评分Ⅱ（APACHE Ⅱ）、乳酸、mLUS、氧合指数等指标差异有统计学意义（P＝0.048，0.000，0.048，0.000，0.004）。单因素分析示APACHE Ⅱ评分、乳酸、mLUS、氧合指数与住院病死率相关，纳入有意义的临床指标进行多因素分析示，乳酸、mLUS为影响ICU休克患者预后的独立危险因素（P＝0.006，0.045；AUC＝0.793，0.733）。结论改良的肺超失充气评分与乳酸同为ICU内休克患者预后的独立预测因素。

ObjectiveTo investigate the prognostic value of modified lung ultrasound aeration loss score（mLUS） in shock patients in intensive care unit（ICU）.MethodsThis was a prospective study.Shock patients who were admitted to ICU from April 2016 to August 2016 were eligible; 90 consecutive shock patients were enrolled.Chest ultrasound examination were done within the first 6 hours after included. The mLUS and other ultrasound variables were recorded as well as the clinical data and the outcome. Data has been analyzed, and a bivariate logistic regression model was established to identify the correlation between mLUS on admission and the ICU mortality.ResultsThe mean APACHE Ⅱ score, lactate, mLUS were significantly increased in non-survivors while the PaO2/FiO2 was decreased in these patients（P=0.048, 0.000, 0.048, 0.000, 0.004）. The univariate analysis revealed that the above variables were significantly related to ICU mortality.The multivariate analysis demonstrated that mLUS are the independent risk factors of ICU mortality as well as the lactate（P=0.045, 0.006; AUC=0.733, 0.793, respectively）.ConclusionModified lung ultrasound aeration loss score can predict the outcome of shock patients in ICU.