急性呼吸窘迫综合征患者28 d生存的影响因素及预后预测因子分析

Influencing factors of 28-day survival and prognostic factors in patients with acute respiratory distress syndrome

目的探讨急性呼吸窘迫综合征(ARDS)患者28 d生存的影响因素及预后预测因子。方法回顾性分析2017年4月至2020年4月成都三六三医院重症监护病房收治的100例ARDS患者的临床资料,依据患者28 d生存情况分为预后良好(存活,n=45)、预后不良组(死亡,n=55)。收集2组患者基础资料信息;对比2组基础资料信息差异;将有差异信息纳入logistic模型,行量化赋值,以预后为因变量(Y,不良=1),以年龄、是否合并下呼吸道感染、是否使用免疫抑制药物、发病至受治时间、有创机械通气时间、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、氧合指数(OI)、每搏输出量变异度(SVV)为自变量(X),明确ARDS患者预后不良的危险因素;最后通过一致性分析探讨各项危险因素预测ARDS患者预后的准确率。结果预后不良组年龄≥65岁、合并下呼吸道感染、使用免疫抑制药物、SVV<15%患者占比显著高于预后良好组,发病至受治时间显著长于预后良好组,有创机械通气时间显著短于预后良好组,APACHEⅡ评分显著高于预后良好组,OI显著低于预后良好组,差异均有统计学意义(P值均<0.05)。经多因素logistic分析证实,年龄≥65岁、下呼吸道感染、使用免疫抑制药物、发病至受治时间>7 d、有创机械通气时间<100 h、APACHEⅡ评分≥20分、OI<130 mmHg(1 mmHg=0.133 kPa)、SVV<15%为ARDS患者预后不良的危险因素(P值均<0.05)。经一致性分析,年龄、下呼吸道感染、使用免疫抑制药物、发病至受治时间、有创机械通气时间、APACHEⅡ评分、OI、SVV均可用于ARDS患者预后的预测(Kappa=0.543、0.544、0.607、0.548、0.545、0.606、0.661、0.573)。结论重症监护病房ARDS患者28 d死亡的影响因素较多,如年龄、是否合并下呼吸道感染、是否使用免疫抑制药物、发病至受治时间、有创机械通气时间、APACHEⅡ评分、OI、SVV,临床医师应当予以关注。

Objective To investigate the influencing factors of 28-day survival and prognostic factors in patients with acute respiratory distress syndrome(ARDS).Methods The clinical data of 100 patients with ARDS admitted to intensive care unit in Chengdu 363 Hospital from April 2017 to April 2020 were retrospectively analyzed.According to the 28-day survival situation,the patients were divided into good prognosis group(survival,n=45)and poor prognosis group(death,n=55).The basic information of the two groups was collected.The difference of basic information between the two groups was compared.The difference information was included in the logistic model,and the quantitative evaluation was performed.The prognosis was taken as the dependent variable(Y,bad=1),and the age,whether combined with lower respiratory tract infections,whether to use immunosuppressive drugs,the time from onset to treatment,the time of invasive mechanical ventilation,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,oxygenation index(OI)and stroke volume variability(SVV)were independent variables(X),to identify the risk factors of poor prognosis in patients with ARDS.Finally,the accuracy of predicting the prognosis of patients with ARDS was analyzed by consistency.Results In the poor prognosis group,the proportions of patients aged≥65 years old,combined with lower respiratory tract infections,using immunosuppressive drugs,and SVV<15%were significantly higher,the time from onset to treatment was significantly longer,the time of invasive mechanical ventilation was significantly shorter,APACHEⅡscore was significantly higher,and OI was significantly lower compared with the good prognosis group,and the differences were statistically significant(all P<0.05).The multi-factor logistic analysis confirmed that≥65 years old,lower respiratory tract infections,the use of immunosuppressive drugs,time from onset to treatment>7 days,time of invasive mechanical ventilation<100 hours,APACHEⅡscore≥20,OI<130 mmHg(1 mmHg=0.098 kPa),SVV<15%were risk factors for poor prognosis in ARDS patients(all P<0.05).The consistency analysis showed that age,lower respiratory tract infections,the use of immunosuppressive drugs,time from onset to treatment,time of invasive mechanical ventilation,APACHEⅡscore,OI,SVV could be used to predict the prognosis of ARDS patients(Kappa=0.543,0.544,0.607,0.548,0.545,0.606,0.661,0.573).Conclusions There are many influencing factors for 28-day death of ARDS patients in intensive care unit,such as age,whether combined with lower respiratory tract infections,whether to use immunosuppressive drugs,time from onset to treatment,time of invasive mechanical ventilation,APACHEⅡscore,OI and SVV,clinicians should pay attention to.