乳酸清除率与胸腔液体含量对ARDS患者的预后价值分析

Analysis of the prognostic value of lactate clearance rate and thoracic fluid content in ARDS patients

目的:探讨乳酸清除率(LCR)与胸腔液体含量(TFC)对急性呼吸窘迫综合征(ARDS)患者预后价值分析。方法:回顾性选择2019年1月—2020年12月期间重症监护室收治住院的71例ARDS患者,以患者诊断为ARDS作为研究起点,根据患者28 d预后分为存活组和死亡组,根据柏林诊断标准将患者分为轻中重度3个亚组。比较ARDS患者一般信息,包括性别、年龄、病因;氧合指数(OI)、呼气末正压(PEEP);24 h内急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ);28 d预后;诊断ARDS后1 h内降钙素原(PCT)、白细胞计数(WBC)、TFC、乳酸(Lac)及24 h LCR。分析筛选ARDS患者死亡的危险因素并绘制受试者工作特征曲线(ROC),分析LCR及TFC对ARDS患者预后的预测价值。结果:71例ARDS患者中,男50例,女21例;年龄51~73岁,平均62岁;其中轻度ARDS患者19例,中度ARDS患者35例,重度ARDS患者17例;28 d存活18例(存活组),死亡53例(死亡组)。重度组与轻度ARDS组相比,重度组APACHEⅡ评分高、Lac高、LCR低、病死率高,与中度ARDS组相比,两组PEEP比较有统计学意义(均P<0.05)。与存活组相比,死亡组APACHEⅡ评分高、OI低、Lac高、LCR低、TFC高,两组比较差异有统计学意义(均P<0.05)。单因素及多因素Logistic回归分析结果APACHEⅡ评分、OI、Lac、LCR、TFC均为ARDS预后的危险因素,LCR及TFC为ARDS患者死亡的独立危险因素(均P<0.05)。ROC曲线显示,LCR[曲线下面积(AUC)=0.883,95%可信区间(95%CI):0.797~0.968,P<0.01]、TFC(AUC=0.922,95%CI:0.826~1.000,P<0.01)及两者联合LCR+TFC(AUC=0.971,95%CI:0.936~1.000,P<0.01),两者联合与单一指标比较差异无统计学意义(Z值分别为1.8511、0.9387,均P>0.05)。结论:LCR及TFC是ARDS患者死亡的独立危险因素,LCR、TFC及两者联合均可作为ARDS患者预后评估有效的指标,但二者联合不能提高ARDS患者死亡危险性预测的准确度。

Objective:To explore the prognostic value of lactate clearance rate(LCR)and thoracic fluid content(TFC)in patients with acute respiratory distress syndrome(ARDS).Methods:A retrospective review of 71 ARDS patients.Taking patients diagnosed as ARDS as the starting point of the study,the patients were divided into survival group and death group according to the 28-day prognosis of patients,and the patients were divided into three subgroups of mild,moderate and severe according to the Berlin diagnostic criteria.Compare general information of ARDS patients,including gender,age,etiology;oxygenation index(OI),positive end expiratory pressure(PEEP);Acute physiology and chronic health scoreⅡ(APACHEⅡ)within 24 hours;28 d prognosis;After diagnosis of ARDS procalcitonin(PCT),White Blood Cell(WBC),TFC,Lactic acid(Lac)and 24 h LCR.Analyze and screen the risk factors of death in ARDS patients and draw receiver operator characteristic(ROC),analyze the predictive value of LCR and TFC on the prognosis of ARDS patients.Results:A total of 71 patients with ARDS were enrolled,50 males and 21 females;age 62(51,73)years old;19 patients with mild ARDS,35 patients with moderate ARDS,17 patients with severe ARDS,28 days of survival 18 cases and 53 deaths.Compared with the mild ARDS group,the severe group had high APACHEⅡscore,high Lac,low LCR,and high mortality rate.Compared with the moderate ARDS group,the PEEP comparison between the two groups was statistically significant(all P<0.05).Compared with the survival group,the death group had high APACHEⅡscores,low OI,high Lac,low LCR,and high TFC.The difference between the two groups was statistically significant(all P<0.05).Single factor and multivariate Logistic regression analysis results:APACHEⅡscore,OI,Lac,LCR,TFC are all risk factors for the prognosis of ARDS,and LCR and TFC are independent risk factors for death in ARDS patients(all P<0.05).ROC curve shows that LCR[area under the curve(AUC)=0.883,95%confidence interval(95%CI):0.797-0.968,P<0.01],TFC(AUC=0.922,95%CI:0.826-1.000,P<0.01)and the two combined LCR+TFC(AUC=0.971,95%CI:0.936-1.000,P<0.01),there was no statistically significant difference between the two combined and a single index(Z values were 1.8511,0.9387,both P>0.05).Conclusion:LCR and TFC are independent risk factors for death in ARDS patients.LCR,TFC and their combination can be used as effective indicators for prognostic evaluation of ARDS patients,but the combination of the two cannot improve the accuracy of the prediction of the risk of death in ARDS patients.