急诊重症监护室急性失代偿性肺高压患者的预后及其危险因素分析

Prognosis and its risk factors of patients with acute decompensated pulmonary hypertension in emergency intensive care unit

目的探讨急性失代偿性肺高压患者的预后及其危险因素,旨在为急性失代偿性肺高压患者的临床管理提供依据。方法选取2015年4月至2020年4月我院急诊重症监护室诊治的287例急性失代偿性肺高压患者。根据是否发生院内死亡将患者分为生存组(n=140)和死亡组(n=147)。比较2组患者临床特征、实验室检查、治疗方案、临床事件及预后情况。利用多因素回归分析评价患者院内死亡率与欧洲心脏学会/欧洲呼吸学会(ESC/ERS)风险评估体系及SOFA评分的相关性。利用受试者操作特征(ROC)曲线分析ESC/ERS风险评估体系及SOFA评分对患者临床预后的评价效能。结果与生存组比较,死亡组ERS/ESC危险分层中、高危险及纽约心脏学会心功能分级Ⅲ、Ⅳ级比例显著增加;平均肺动脉压和N末端B型利钠肽原(NT-proBNP)明显升高;动脉血氧分压(PaO2)及三尖瓣环收缩期运动幅度(TAPSE)明显降低,差异均有统计学意义(均P<0.05)。多因素分析结果显示,SOFA评分≥8、ESC/ERS危险分级高危、NT-proBNP和PaO2是急性失代偿性肺高压患者院内死亡的独立危险因素(均P<0.05)。ROC曲线分析结果显示,ERS/ESC危险分级高危联合SOFA评分≥8的曲线下面积最大,为0.877;灵敏度为92.5%,特异度为83.0%。结论ERS/ESC危险分级高危及SOFA评分≥8是预测急性失代偿性肺高压患者院内死亡的独立危险因素。ERS/ESC危险分级及SOFA评分可以作为评价重症监护病房中急性失代偿性肺高压患者预后的指标,且二者联合的预测效能更高。

Objective To discuss the prognosis and its risk factors in patients with acute decompensatory pulmonary hypertension and provide a basis for their clinical management.Methods A total of 287 patients with acute decompensated pulmonary hypertension patients were selected in our hospital's Emergency Intensive Care Unit between April 2015 and April 2020.Patients were divided into a survival group(n=140)and a death group(n=147)according to in-hospital mortality status.The clinical characteristics,laboratory examination results,treatment plans,clinical events,and prognoses were compared between groups.The correlation between the in-hospital mortality rate,European Society of Cardiology/European Respiratory Society(ESC/ERS)risk assessment system score,and Sequential Organ Failure Assessment(SOFA)score were evaluated using multivariate regression analysis.The ESC/ERS risk assessment system and SOFA scores were analyzed to evaluate the efficiency of clinical prognosis using a receiver operating characteristic(ROC)curve.Results Compared with the survival group,in the death group,the rates of intermediate and high risk in the ESC/ERS assessment and NYHAⅢ/Ⅳclass were increased(P<0.05),the mean pulmonary artery pressure and N-terminal pro-BNP(NT-proBNP)level were considerably elevated(P<0.05),and the levels of arterial partial pressure of oxygen(PaO2)and tricuspid annular plane systolic extrusion were considerably reduced(P<0.05).On a multivariate Cox regression analysis,a SOFA score≥8,high ESC/ERS risk assessment score,and high NT-proBNP and PaO2 levels were independent risk factors for in-hospital mortality(all P<0.05).A ROC curve analysis showed that the area under the curve of the ESC/ERS risk assessment combined with SOFA score was the largest at 0.877(P<0.001),with a sensitivity of 92.5%and specificity of 83.0%.Conclusion High risk on an ESC/ERS risk assessment and a SOFA score≥8 are independent risk factors of in-hospital mortality among patients with acute decompensatory pulmonary hypertension.The ESC/ERS risk assessment and SOFA score can be used to evaluate the prognosis of patients with acute decompensated pulmonary hypertension in the Intensive Care Unit;moreover,their combined use has better predictive efficacy.