肺泡动脉氧分压差对急性肺栓塞患者远期预后的影响

Influence of alveolar-arterial oxygen gradient on prognosis of patients with acute pulmonary embolism

目的探讨肺泡动脉氧分压差[P_((A-a))O_2]对急性肺栓塞(APE)患者远期生存状况的影响。方法回顾性收集2011~2016年在唐山市3所三甲医院首次确诊为APE患者的病历资料,并电话随访收集患者的生存信息。根据P_((A-a))O_2与APE患者预后的ROC曲线,将患者分成2组:P_((A-a))O_2<41.5 mm Hg组和P_((A-a))O_2≥41.5 mm Hg组。采用Kaplan-Meier法绘制生存曲线,采用COX比例风险回归模型分析P_((A-a))O_2水平与APE患者出院后死亡的关系。结果共432例APE患者进入分析,其中59例发生出院后死亡。P_((A-a))O_2<41.5 mm Hg组和P_((A-a))O_2≥41.5 mm Hg组的出院后病死率分别为2.7%和31.0%,调整其他影响因素后,P_((A-a))O_2≥41.5 mmHg可提高APE患者的出院死亡风险[H~^R=1.776(95%CI:1.006,3.136)]。结论P_((A-a))O_2水平可以预示APE患者的预后。

Objective To explore the effect of alveolar-arterial oxygen gradient[P(A-a)O2]level at the admission on the prognosis of the patients with acute pulmonary embolism(APE).Methods The medical records of the patients who were firstly confirmed APE in 3 first-class hospitals at grade 3 in Tangshan from 2011 to 2016 were retrospectively collected.The survival information of the patients was collected by telephone follow-up.According to P(A-a)O2 and the ROC curve of the prognosis of the APE patients,the patients were divided into two groups:P(A-a)O2<41.5 mmHg group and P(A-a)O2≥41.5 mmHg group.Kaplan-Meier curve was used to compare cumulative survival rate between the two groups.COX proportional hazards regression model was used to analyze the predictive value of alveolar-arterial oxygen gradient on the prognosis of APE patients.Results A total of 432 APE patients were included in the study,among which 59 patients died after discharge.The post-discharge mortality was 2.7%in the P(A-a)O2<41.5 mmHg group and 31.0%in the P(A-a)O2≥41.5 mmHg group.After adjusting for other influencing factors,P(A-a)O2≥41.5 mmHg increased the risk of death[H^R=1.776(95%CI:1.006,3.136)].Conclusions P(A-a)O2 can be used to predict the prognosis of the patients with APE.