肺动脉顺应性在急性呼吸窘迫综合征中的价值

Value of pulmonary artery compliance in acute respiratory distress syndrome

目的检测急性呼吸窘迫综合征(ARDS)患者肺动脉顺应性及右心功能,探讨肺动脉顺应性与右心功能及ARDS短期预后的关系。方法选取同期135例ARDS患者(观察组)及46例健康体检者(对照组)为研究对象,根据30 d预后情况分为死亡组89例、生存组46例。检测受试者肺动脉收缩压(PASP),计算房间隔缺损面积指数(ASD-AI)、肺动脉顺应性指数(PACI),并以PACI作为评价肺动脉顺应性的指标;检测受试者每搏输出量(RVSV)等右心功能指标;分析PACI与右心功能的相关性;比较不同预后情况患者的PASP、ASD-AI、PACI水平;分析PACI对ARDS患者近期预后的预测价值。结果观察组患者PASP、ASD-AI、心室舒张末期容积(RVEDV)、动脉血二氧化碳分压[p_(a)(CO_(2))]水平均高于对照组,PACI、右心室射血分数(RVEF)、心室收缩末期容积(RVESV)、平均动脉压(MAP)、动脉血氧分压[p_(a)(O_(2))]、氧合指数[p_(a)(O_(2))/FiO_(2)]水平均低于对照组,差异有统计学意义(P<0.05)。ARDS患者PACI与RVEF、RVESV及p_(a)(O_(2))/FiO_(2)呈正相关(P<0.05),与RVEDV呈负相关(P<0.05)。死亡组患者PASP、ASD-AI水平高于生存组,PACI、p_(a)(O_(2))/FiO_(2)水平低于生存组,差异有统计学意义(P<0.05)。受试者工作特征(ROC)曲线显示,PACI对ARDS短期预后诊断的曲线下面积(AUC)为0.844,敏感性为70.8%,特异性为80.4%。结论ARDS患者肺动脉顺应性和右心功能下降,PACI与右心功能存在一定相关性,PACI在ARDS患者近期预后中能够起到较好的预测作用。

Objective To detect pulmonary artery compliance and right heart function in patients with acute respiratory distress syndrome(ARDS),and to explore the relationships between pulmonary artery compliance and right heart function as well as short-term prognosis of ARDS.Methods A total of 135 ARDS patients(observation group)and 46 healthy subjects(control group)were selected as subjects.According to the prognosis of 30 days,they were divided into death group(n=89)and survival group(n=46).Pulmonary artery systolic pressure(PASP)was measured,atrial septal defect area index(ASD-AI)and pulmonary arterial compliance index(PACI)were calculated,and PACI was used as indicators to evaluate the compliance of pulmonary artery;stroke volume(RVSV)and other indicators of right heart function were measured;the correlation between PACI and right heart function was analyzed;the levels of PASP,ASD-AI and PACI in patients with different prognosis were compared;the value of PACI in predicting short-term prognosis ARDS of patients was analyzed.Results PASP,ASD-AI,right ventricular end-diastolic volume(RVEDV)and arterial partial pressure of carbon dioxide[p_(a)(CO_(2))]in the observation group were significantly higher,and PACI,right ventricular ejection fraction(RVEF),right ventricular end-systolic volume(RVESV),mean arterial pressure(MAP),arterial partial pressure of oxygen[p_(a)(O_(2))]and oxygenation index[p_(a)(O_(2))to FiO_(2)] were significantly lower than those in the control group(P<0.05).In ARDS patients,PACI was positively correlated with RVEF,RVESV and p_(a)(O_(2))/FiO_(2)(P<0.05),and negatively correlated with RVEDV(P<0.05).PASP and ASD-AI levels in the death group were significantly higher,PACI and p_(a)(O_(2))/FiO_(2) levels were significantly lower than those in the survival group(P<0.05).Receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)of PACI for the short-term prognosis of ARDS was 0.844,the sensitivity was 70.8%,and the specificity was 80.4%.Conclusion In ARDS patients,pulmonary artery compliance and right heart function both decrease.PACI has a certain correlation with right heart function,and PACI can play a role in predicting the short-term prognosis of ARDS patients.