急性呼吸窘迫综合征患者机械通气不同时间点氧合指数及对预后的评估价值

Evaluation value of oxygenation index and prognosis in patients with acute respiratory distress syndrome at different time points

目的研究急性呼吸窘迫综合征(ARDS)患者机械通气不同时间点氧合指数及对预后的评估价值.方法采取回顾性分析,选取2015年3月~2017年11月确诊为ARDS患者89例,所有患者均进行机械通气治疗,将患者按28d预后分为存活组47例与死亡组42例,按氧合指数情况将存活患者再分为高水平氧合指数组22例和低水平氧合指数组25例.观察两组患者MV即刻(0h)、早期肺复张(RM)后与MV6、12、24h氧合指数及MV即刻与MV24h生命体征(心率(HR)、收缩压(SBP)、呼吸频率(RR)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)指标变化、与MV时间和呼吸机相关参数(呼气末正压(PEEP)、潮气量(VT)、分钟通气量(VE)、肺动态顺应性(Cdyn)),评估不同时间点氧合指数对ARDS患者28 d预后的预测价值.结果两组MV0h氧合指数比较无显著差异(P>0.05),存活组RM后、MV6h、MV12h、MV24h氧合指数显著高于死亡组(P<0.05);高水平氧合指数组在MV6h、MV12h、MV24h时间氧合指数显著高于低水平氧合指数组(P<0.05);MV 24 h死亡组PEEP显著高于存活组,而Cdyn、VT、VE显著低于存活组(均P<0.05);RM后氧合指数作为预后指标,AUC为0.670;MV 6、12及24 h氧合指数对ARDS患者预后预测价值较高,AUC分别为0.732、0.746、0.762,但MV5h、MV12h、MV24h氧合指数差异无统计学意义.结论急性呼吸窘迫综合征患者机械通气早期肺复张后氧合指数可作为评估患者预后的指标,具有临床应用价值.

Objective To investigate the evaluation value of oxygenation index and prognosis in patients with acute respiratory distress syndrome(ARDS) at different time points.Methods 89 ARDS diagnosed from March 2015 to November 2017 were selected and retrospectively analyzed. All patients received the mechanical ventilation(MV), and then were divided into survival group(47 cases) and death group(42 cases) according to 28 d prognosis. The survival group was further divided into two subgroups, namely, high-level oxygenation index group(n=22, oxygenation index ≥150 mmHg, 1 mmHg=0.133 kPa) and low-level oxygenation index group(n=25, oxygenation index<150 mmHg), according to oxygenation index at different time points of MV. The oxygenation index was calculated at MV immediately, after recruitment maneuver(RM) and at 6, 12, 24 hours of MV, moreover, the vital signs [heart rate(HR), systolic blood pressure(SBP), respiratory rate(RR), arterial partial pressure of oxygen(PaO2), arterial partial pressure of carbon dioxide(PaCO2)], and ventilator related parameters [positive end-expiratory pressure(PEEP), minute ventilation(VE), tidal volume(VT), and pulmonary dynamic compliance(Cdyn)]were measured at MV immediately and 24 hours of MV. Then the predictive value of oxygenation index at different time points for the 28 d prognosis of ARDS was analyzed. Results The oxygenation index of the two groups after RM, MV6 h, MV12 h and MV24 h was significantly higher than that of MV0 h(P<0.05), no difference was found at the MV0 h(P>0.05). The oxygenation index of survival group was significantly higher than that of death group after RM, MV6 h, MV12 h and MV24 h(P<0.05), no difference was found at the MV0 h(P>0.05). The low level oxygenation index group was significantly higher than the high level oxygenation index group at MV6 h, MV12 h and MV24 h(P<0.05). The PEEP, VT and VE levels of death group was significantly higher than the survival group at MV 24 h, while Cdyn was significantly lower than the survival group(P<0.05). Taking the oxygenation index after RM as prognostic index, the AUC was 0.670;oxygenation index at MV 6 h, 12 h and 24 h had higher prognostic value for ARDS patients, AUC were 0.732, 0.746, 0.762, respectively, while no difference was found in oxygenation index at MV5 h, MV12 h, MV24 h. Conclusion The oxygenation index of patients with ARDS after early pulmonary retraction can be used as the main index to evaluate the prognosis of patients, furthermore, the oxygenation index after MV is the key time point for predicting the 28 d prognosis, which is worthy of promotion.