动脉血乳酸、氧合指数、D-二聚体对老年重症肺炎患者并发急性呼吸窘迫综合征的预测价值

Predictive value of arterial blood lactic acid,oxygenation indexes and D-dimer in elderly patients with severe pneumonia complicated with acute respiratory distress syndrome

目的分析动脉血乳酸、氧合指数、D-二聚体对老年重症肺炎患者并发急性呼吸窘迫综合征的预测价值。方法回顾性分析北京大学第三医院延庆医院2016年3月—2020年3月收治的219例老年重症肺炎患者,按是否并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)分为ARDS组和非ARDS组,先后采用单因素分析和多因素Logistic回归分析对相关危险因素进行分析,采用受试者工作曲线(ROC)评估独立危险因素对并发ARDS的预测价值。结果219例患者中共有107例患者并发ARDS,发生率为48.86%。单因素分析结果发现休克、肺炎严重程度评分(PSI)、动脉血乳酸(lactic acid,Lac)、白蛋白、D-二聚体和氧合指数(oxygenation index,OI)组间比较差异有统计学意义(P<0.05)。经多因素Logistic回归分析,结果发现PSI评分、Lac、D-二聚体、OI是并发ARDS的独立危险因素(P<0.05)。ROC检验发现,预测并发ARDS时,PSI评分有较高准确性,Lac有一定准确性,D-二聚体和OI有较低准确性(P<0.05)。结论Lac、OI和D-二聚体均对老年重症肺炎并发ARDS具有一定预测价值,可用于辅助评估预后。

Objective To investigate the predictive value of arterial blood lactic acid,oxygenation indexes and D-dimer in elderly patients with severe pneumonia complicated with acute respiratory distress syndrome(ARDS).Methods The clinical data on 219 elderly patients with severe pneumonia treated between March 2016 and March 2020 was retrospectively analyzed.The patients were divided into the ARDS group and non-ARDS group.Univariate analysis and logistic regression analysis were used to analyze the related risk factors while the receiver operating curve(ROC)was used to evaluate the predictive value of independent risk factors for ARDS.Results There were 107 patients with ARDS among the 219 patients with severe pneumonia,so the incidence was 48.86%.Univariate analysis showed that shock,the PSI,arterial blood lactic acid(Lac),albumin,D-dimer and the oxygenation index(OI)were significantly different between the two groups(P<0.05).Logistic multivariate regression analysis results suggested that the PSI,Lac,D-dimer and OI were independent risk factors for ARDS(P<0.05).ROC test showed that the PSI could help predict complications with ARDS with excellent accuracy,Lac with some accuracy,and D-dimer and OI with low accuracy(P<0.05).Conclusion Lac,OI and D-dimer are all of some predictive value for ARDS in elderly patients with severe pneumonia,which can be used to assist in the evaluation of prognosis.