无创呼吸机对重症急性胰腺炎合并急性呼吸窘迫综合征治疗失败的危险因素预测

Risk factors of noninvasive ventilator treatment failure in patients with severe acute pancreatitis complicated with acute respiratory distress syndrome

目的:探讨无创呼吸机对重症急性胰腺炎(SAP)合并急性呼吸窘迫综合征(ARDS)患者治疗失败的危险因素,分析危险因素对治疗失败的预测价值。方法:收集2019年5月—2022年5月急诊重症病房(EICU)收治的SAP合并ARDS患者的临床资料,根据无创呼吸机治疗成功与否将患者分为失败组与成功组。收集患者基本资料、实验室检查结果、并发症发生人数及危重症相关评分等。采用二元logistic回归分析SAP合并ARDS患者无创呼吸机治疗失败的独立危险因素,运用受试者工作特征曲线(ROC)分析危险因素的预测价值。结果:符合纳入标准病例227例,失败组82例,成功组145例。失败组性别比、年龄、BMI、基础疾病史、吸烟史、大量饮酒史、胆道疾病、高甘油三酯血症、轻中重度ARDS、ICU住院天数、心率、MAP、PaO2/FiO2、HbA1c、Alb、RANSON评分、BISAP评分、镇静药物、血液净化与成功组比较,差异无统计学意义(P>0.05);2组间APACHEⅡ评分、CTSI评分、CRP、IL-6、腹腔压力、ACS比较,差异有统计学意义(P<0.05);二元logistic回归分析显示,CTSI评分、IL-6、腹腔压力是治疗失败的独立危险因素(P<0.05)。ROC曲线结果显示,IL-6较另外2个因素更具有预测价值,其截断值为110.45 pg/mL,灵敏度和特异度分别为0.683、0.317,曲线下面积(AUC)为0.841(95%CI:0.787~0.895,P=0.001)。结论:CTSI评分、IL-6、腹腔压力是SAP合并ARDS患者无创呼吸机治疗失败的独立危险因素,其中IL-6对于SAP合并ARDS患者无创呼吸机治疗失败具有预测价值。

Objective:To investigate the risk factors of non-invasive ventilator for treatment failure in patients with severe acute pancreatitis(SAP)complicated with acute respiratory distress syndrome(ARDS),and to analyze the predictive value of risk factors for treatment failure.Methods:Clinical data of SAP patients with ARDS admitted to the emergency intensive care unit(EICU)from May 2019 to May 2022 were collected,and the patients were divided into failure group and success group according to the success of non-invasive ventilator treatment.Basic data such as gender,age,body mass index(BMI),smoking history,heavy alcohol consumption history,heart rate,and mean arterial pressure(MAP)were collected.Imaging and laboratory results were collected,such as the number of biliary diseases and hypertriglyceridemia,glycosylated hemoglobin(HbA1c),C-reactive protein(CRP),interleukin 6(IL-6),serum albumin(Alb),and oxygenation index(PaO2/FiO2).The number of patients with intraperitoneal compartment syndrome(ACS)and moderate to severe ARDS were collected.The number of patients receiving sedative drugs and blood purification treatment was collected.Patients’critical illness scores,such as APACHEⅡscore,RANSON score,BISAP score and CTSI score,were collected.The independent risk factors of non-invasive ventilator treatment failure in SAP patients with ARDS were analyzed by binary logistic regression,and the predictive value of risk factors was analyzed by receiver operating characteristic curve(ROC).Results:A total of 227 cases met the inclusion criteria,including 82 cases in the failed group and 145 cases in the successful group.By comparison,There was no significant difference in sex ratio,age,BMI,smoking history,heavy drinking history,biliary tract disease,hypertriglyceridemia,moderate to severe ARDS,length of ICU stay,heart rate,MAP,PaO2/FiO2,HbA1c,Alb,RANSON score,BISAP score,sedate drugs,blood purification between the failed group and the successful group(P>0.05);APACHEⅡscore,CTSI score,CRP,IL-6,abdominal pressure and ACS were statistically significant between the two groups(P<0.05).Binary logistic regression analysis showed that CTSI score,IL-6 and abdominal pressure were independent risk factors for treatment failure(P<0.05).ROC curve results showed that IL-6 had higher predictive value than the other two factors,with a cut-off value of 110.45,sensitivity and specificity of 0.683 and 0.317,respectively,and area under the curve(AUC)of 0.841(95%CI:0.77-0.895,P=0.002).Conclusion:CTSI score,IL-6 and abdominal pressure are independent risk factors for non-invasive ventilator treatment failure in SAP patients with ARDS,and IL-6 has a guiding role in predicting non-invasive ventilator treatment failure in SAP patients with ARDS.