定量CT肺密度在慢性阻塞性肺疾病急性加重患者气管插管中的预测价值

Predictive value of quantitative CT lung density in tracheal intubation of the patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨定量CT肺密度在慢性阻塞性肺疾病急性加重(AECOPD)患者气管插管中的预测价值。方法回顾性分析广州医科大学附属第一医院急诊科2019年1月至2023年12月收治的78例AECOPD患者,依据住院期间接受不同类型的机械通气方式分为对照组(无创呼吸机辅助通气,n=50)和研究组(气管插管辅助通气,n=28),收集并分析两组一般资料、实验室检查和定量CT肺密度参数,通过多因素Logistic回归分析探索各因素对气管插管结局的影响程度,最后采用受试者工作特征(ROC)曲线分析定量CT肺密度参数对气管插管结局的预测价值。结果与对照组比较,研究组降钙素原(PCT)、低通气肺组织、无通气肺组织、受损肺组织百分率升高,二氧化碳分压(PaCO_(2))和氧合指数(PaO_(2)/FiO_(2))降低,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,受损肺组织[OR(95%CI)=1.207(1.030~1.415)]是AECOPD气管插管的危险因素(P<0.05)。Spearman相关性分析显示,受损肺组织与PaO_(2)/FiO_(2)呈负相关(r s=-0.516,P<0.001)。ROC曲线分析显示,受损肺组织[曲线下面积(AUC)=0.705]对AECOPD患者气管插管具有显著预测价值(P<0.05),截断值为11.5%。结论受损肺组织可预测AECOPD患者气管插管,为早期识别重症患者提供帮助。

Objective To investigate the predictive value of quantitative CT lung density in tracheal intubation of the patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A retrospective analysis was conducted on a total of 78 AECOPD patients admitted to the Emergency Department of the First Affiliated Hospital of Guangzhou Medical University from January 2019 to December 2023.Patients were divided into the control group(non-invasive ventilator-assisted ventilation,n=50)and the study group(tracheal intubation-assisted ventilation,n=28)based on different mechanical ventilation methods during hospitalization.Afterward,general data,laboratory tests and quantitative CT lung density parameters were collected and analyzed between the two groups.Moreover,the influence of different factors on the outcome of tracheal intubation was investigated by the multivariate Logistic regression analysis.Finally,the predictive value of quantitative CT lung density parameters in the outcome of tracheal intubation was analyzed by using the receiver operating characteristic(ROC)curve.Results Compared with the control group,the study group had a higher procalcitonin(PCT),the percentage of hypoventilation lung tissue,non-aerated lung tissue and damaged lung tissue and a lower arterial partial pressure of carbon dioxide(PaCO_(2))and PaO_(2)/FiO_(2),and the differences were statistically significant(P<0.05).Meanwhile,multivariate Logistic regression analysis revealed that damaged lung tissue[OR(95%CI)=1.207(1.030-1.415)]was a risk factor for tracheal intubation in AECOPD(P<0.05).Additionally,Spearman correlation analysis showed that damaged lung tissue was negatively correlated with PaO_(2)/FiO_(2)(r s=-0.516,P<0.001).Furthermore,ROC curve analysis showed that damaged lung tissue(AUC=0.705)provided a significantly predictive value for tracheal intubation in AECOPD patients(P<0.05),with a cut-off value of 11.5%.Conclusions Damaged lung tissue can predict tracheal intubation in AECOPD patients and assist in the early identification of critical patients.