肺泡动脉氧分压差与氧合指数预测COPD并肺炎致感染性休克患者发生ARDS

Alveolar Arterial Oxygen Partial Pressure Difference and Oxygenation Index Prediction of Acute Respiratory Distress Syndrome in Patients with Chronic Obstructive Pulmonary Disease and Sepsis Shock Caused by Pneumonia

目的探讨肺泡动脉氧分压差(P(A-a)O2)与氧合指数(OI)在预测慢性阻塞性肺疾病(COPD)并肺炎致感染性休克患者发生急性呼吸窘迫综合征(ARDS)的价值。方法选取黔东南苗族侗族自治州人民医院2016年1月—2018年2月入住ICU的社区获得性肺炎至休克的COPD病人,在入住ICU时查P(A-a)O2及OI。以诊断肺炎7 d内是否发生ARDS。将患者分为ARDS组(A组)及非ARDS组(B组),比较两组性别、年龄P(A-a)O2及OI的差异,分析P(A-a)O2及OI与ARDS的相关性,绘制受试者工作特征曲线(ROC)分析P(A-a)O2及OI对发生ARDS的预测能力。结果A组P(A-a)O2高于B组,A组OI低于B组,差异均有统计学意义(P<0.001)。ARDS与P(A-a)O2及OI相关(P<0.001)。P(A-a)O2预测发生ARDS的ROC曲线下面积(AUC)为0.931(0.873,0.988),截断值为214.70,敏感性为89.50%,特异性为85.00%;OI预测发生ARDS的AUC为0.858(0.774,0.937),截断值为172.75,敏感性为90.00%,特异性为71.11%。结论P(A-a)O2及OI是判断COPD并感染性休克患者发生ARDS的较好预测指标。

Objective To explore the value of alveolar arterial oxygen partial pressure difference(P(A-a)O2)and oxygenation in?dex(OI)prediction of acute respiratory distress syndrome(ARDS)in patients with chronic obstructive pulmonary disease(COPD)and sepsis shock caused by pneumonia.Methods COPD patients had sepsis shock caused by community-acquired pneumonia admitted in Intensive Care Unit(ICU)in the hospital from January,2016 to February,2018 were selected.P(A-a)O2 and OI were checked.Pa?tients were divided into ARDS group(group A)and no ARDS group(group B)in 7 days after pneumonia diagnosis.To compare the dif?ferences of gender,age,P(A-a)O2 and OI of two groups,the correlation between P(A-a)O2,OI and ARDS was analyzed.The re?ceiver-operating characteristic curve(ROC)was drawn to analyze the ability that P(A-a)O2 and OI prediction of ARDS.Results P(Aa)O2 in group A was higher than group B.OI in group A was lower than group B.There were statistically significant difference(P<0.001).ARDS was related to P(A-a)O2 and OI(P<0.001).P(A-a)O2 predicted ARDS that the area under the ROC curve(AUC)was 0.931(0.873,0.988).The cutoff value was 214.70.Sensitivity was 89.50%.Specificity was 85.00%.OI prediction of ARDS and AUC was 0.858(0.774,0.937).Cutoff value was 172.75.Sensitivity was 90.00%.Specificity was 71.11%.Conclusion P(A-a)O2 and OI were good indicators to prediction of ARDS in patients with COPD and sepsis shock caused by pneumonia.