重症监护病房内休克患者肺部超声评分与不良预后的相关性

Correlation between lung ultrasound score and adverse prognosis in shock patients in intensive care unit

目的探讨重症监护病房(ICU)内休克患者肺部超声评分与不良预后的相关性。方法选取2019年7月至2021年6月梧州市红十字会医院ICU收治的200例休克患者的临床资料进行研究。根据患者的预后情况,分为生存组和死亡组。对不同预后ICU内休克患者的临床资料进行单因素分析、多因素回归分析及预测价值分析。结果所有患者均获得随访,研究终点为患者死亡或转出ICU,随访期为28 d,中位数16 d。所有患者28 d生存率为62.5%(125/200)。生存组与死亡组患者的急性生理与慢性健康(APACHEⅡ)评分、凝血酶原时间(PT)、纤维蛋白原(Fbg)、D-二聚体(D-D)、乳酸、氧合指数、肺部超声评分差异均有统计学意义(均P<0.05),其他指标差异均无统计学意义(均P>0.05)。COX多因素分析结果显示APACHEⅡ评分、乳酸、肺部超声评分是ICU内休克患者预后的独立影响因素(均P<0.05)。不同肺部超声评分患者的生存曲线比较差异有统计学意义(P<0.05),肺部超声评分越高,28 d生存率越低(P<0.05)。ROC曲线分析结果显示,肺部超声评分预测患者预后的AUC、灵敏度、特异度分别为0.753、76.0%、71.2%;APACHEⅡ评分的AUC、灵敏度、特异度分别为0.774、77.3%、79.2%;乳酸的AUC、灵敏度、特异度分别为0.783、81.3%、68.8%,差异无统计学意义(均P>0.05)。结论肺部超声评分与乳酸、APACHEⅡ评分均是影响ICU内休克患者预后的独立危险因素,并且有相当的预测价值。

Objective To investigate the correlation of lung ultrasound score and poor prognosis in internal shock patients in intensive care unit(ICU).Methods The clinical data of 200 shock patients admitted to the ICU of Wuzhou Red Cross Hospital from July 2019 to June 2021 were selected for study.According to the prognosis of patients,they were divided into survival group and death group.The clinical data of shock patients in ICU with different prognosis were analyzed by single factor analysis,multiple factor regression analysis and predictive value analysis.Results All patients were followed up.The end point of the study was death or transfer from ICU.The follow-up period was 28 days,with a median of 16 days.The 28-day survival rate(OS)of all patients was 62.5%(125/200).The Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)score,prothrombin time(PT),Fbg,D-dimer(D-D),lactic acid,oxygenation index and lung ultrasound score of the patients in the survival group and the death group were significantly different(all P<0.05),while other indexes were not significantly different(all P>0.05).The results of COX multivariate analysis showed that APACHEⅡ score,lactate,and lung ultrasound score were independent prognostic factors of shock patients in ICU(all P<0.05).The survival curves of patients with different lung ultrasound scores were significantly different(P<0.05).The higher the lung ultrasound score,the lower the 28-day survival rate(P<0.05).The receiver operating characteristic(ROC)curve analysis showed that the area under curve(AUC),sensitivity and specificity of predicting the prognosis of patients with lung ultrasound score were 0.753,76.0% and 71.2%,respectively;The AUC,sensitivity and specificity of APACHEⅡ score were 0.774,77.3%and 79.2% respectively;The AUC,sensitivity and specificity of lactic acid were 0.783,81.3% and 68.8%respectively,with no significant difference(all P>0.05).Conclusions The lung ultrasound score,lactic acid and APACHEⅡ scores are independent risk factors affecting the prognosis of ICU shock patients,and have considerable predictive value.