毛细血管渗漏指数对脓毒症合并ARDS早期诊断及预后的评估价值

Application of capillary leakage index in the early diagnosis and prognosis evaluation of sepsis complicated with ARDS

目的:研究毛细血管渗漏指数(CLI)对脓毒症合并急性呼吸窘迫综合征(ARDS)早期诊断及预后的评估价值。方法:回顾性分析2015-01—2017-12期间我院收治的62例脓毒症患者的临床资料,根据是否合并ARDS、28d的存活情况,分为ARDS组(n=34)和非ARDS组(n=28)、死亡组(n=29)和存活组(n=33),比较两组患者的基本资料,检测生理及实验室指标,采用Logistic回归分析脓毒症并发ARDS及其预后的危险因素。结果:与非ARDS组比较,ARDS组患者的脓毒症分级、血乳酸、CRP、APACHEⅡ评分、CLI、28d病死率明显升高,ALB明显降低(P<0.05)。与存活组比较,死亡组患者的年龄明显增大,脓毒症分级、血乳酸、CRP、A-PACHEⅡ评分、CLI明显升高,ALB明显降低(P<0.05)。多因素Logistic回归分析显示,APACHEⅡ评分、脓毒症分级、CLI均是脓毒症患者发生ARDS的独立危险因素(P<0.05)。多因素Logistic回归分析显示,年龄、APACHEⅡ评分、血乳酸及CLI均是脓毒症合并ARDS患者28d内死亡的独立危险因素(P<0.05)。结论:CLI可作为脓毒症患者发生ARDS的早期诊断,并能够预测脓毒症合并ARDS患者的预后。

Objective:To explore the evaluation value of capillary leakage index(CLI)in the early diagnosis and prognosis evaluation of sepsis complicated with acute respiratory distress syndrome(ARDS).Method:Sixty-two cases of sepsis patients complicated with ARDS received treatment in our hospital from January 2015 to December 2017 was included,all the cases were divided into ARDS group(n=34)and non ARDS group(n=28),death group(n=29)and survival group(n=33)according to whether ARDS or not and mortality within 28 days.The basic data of the two groups were compared,physiological and laboratory indicators were detected,and Logistic regression was used to analyze the risk factors of ARDS and its prognosis in patients with sepsis.Result:Compared with non ARDS group,ARDS group had higher sepsis grading,blood lactic acid,CRP,APACHEⅡscore,CLI,mortality within 28 days,lower level of ALB(P<0.05).Compared with survival group,the age,sepsis grading,blood lactic acid,CRP,APACHEⅡscore,CLI in death group were increased obviously,and ALB was significantly decreased(P<0.05).Multiple Logistic regression analysis showed that the APACHEⅡscore,grade of sepsis,CLI were independent risk factors for ARDS in patients with sepsis(P<0.05).Multiple Logistic regression analysis showed that age,APACHEⅡscore,blood lactic acid and CLI were independent risk factors for death within 28 days in sepsis patients complicated with ARDS(P<0.05).Conclusion:CLI can be used as an early diagnosis of ARDS caused by sepsis,and it can predict the prognosis of sepsis patients complicated with ARDS.