ECMO治疗重症急性呼吸衰竭患者预后影响因素及OCT10、OCI、APACHEⅣ评分对其预测价值

Prognostic factors of patients with severe acute respiratory failure treated by ECMO and the predictive value of OCT10,OCI and APACHEⅣscores

目的探究体外膜氧合(ECMO)治疗重症急性呼吸衰竭(ARF)患者预后影响因素及OCT10、OCI、急性生理和慢性健康状况(APACHEⅣ)评分对其预测价值。方法选取2018年1月至2019年12月在驻马店市中心医院和河南省人民医院重症科进行治疗的重症ARF患者126例,根据预后分为生存组(68例)和死亡组(58例)。分析预后影响因素以及OCT10、OCI、APACHEⅣ评分预测价值。结果死亡组有Murray肺损伤评分、序贯器官功能衰竭(SOFA)、机械通气时间、APACHEⅣ评分高于生存组,OCT10、OCI水平低于生存组,差异有统计学意义(P<0.05)。多因素Logistic回归显示,OCT10、OCI是ARF患者预后死亡的保护因素,APACHEⅣ评分是ARF患者预后死亡的独立危险因素(P<0.05)。ROC曲线分析显示,OCT10、OCI、APACHEⅣ评分预测ARF患者预后死亡的AUC分别为0.880、0.879、0.765,当OCT低于68.12 mmHg时,其敏感度为80.9%,特异度为88.2%;当OCI低于0.71时,其敏感度为75.0%,特异度为88.2%;当APACHEⅣ评分高于38分时,其敏感度为98.5%,特异度为50.0%。结论OCT10、OCI、APACHEⅣ是ARF患者预后的独立影响因素;且OCT10、OCI及APACHEⅣ评分,均对ARF预后死亡有预测价值。

Objective To explore the factors affecting the prognosis of patients with severe acute respiratory failure(ARF)by extracorporeal membrane oxygenation(ECMO)and the predictive value of OCT10,OCI,acute physiology and chronic health(APACHEⅣ)scores.Methods A total of 126 patients with severe ARF who were treated in Zhumadian Central Hospital and Henan Provincial People’s Hospital from January 2018 to December 2019 were selected.According to the prognosis,they were divided into the survival group(68 cases)and the death group(58 cases).The influencing factors of prognosis and the predictive value of OCT10,OCI,and APACHEⅣscores were analyzed.Results Their Murray lung injury score,sequential organ failure(SOFA),mechanical ventilation time and APACHEⅣscore were higher in the death group than in the survival group,and the levels of OCT10 and OCI were lower in the death group than in the survival group(P<0.05).Multi-factor Logistic regression showed that OCT10 and OCI were protective factors of the prognosis of patients with ARF,APACHEⅣscore was an independent risk factor for the prognosis of patients with ARF(P<0.05).ROC curve analysis showed that the AUC of OCT10,OCI,APACHEⅣscore to predict the prognosis of patients with ARF were 0.880,0.879,and 0.765 respectively.When the value of OCT10 was below 68.12 mmHg,its sensitivity and specificity were 80.9%and 88.2%.When OCI was lower than 0.71,its sensitivity and specificity were 75.0%and 88.2%respectively.When APACHEⅣscore was more than 38 points,its sensitivity and specificity were 98.5%and 50.0%.Conclusion OCT10,OCI,and APACHEⅣscore are independent factors influencing the prognosis of ARF patients;and OCT10,OCI and APACHEⅣscores have predictive value for the prognosis of ARF.