摘要
目的探讨功能残气量(FRC)与机械能(MP)的相关性并评估二者对急性呼吸窘迫综合征(ARDS)患者的预后价值。方法选择锦州医科大学附属第一医院重症医学科2019年11月至2020年12月诊断为ARDS且行有创机械通气治疗的患者63例。根据28 d预后将患者分为存活组(39例)和死亡组(24例),比较两组机械通气治疗后8 h、16h、48 h时FRC、MP、呼吸频率(RR)及最佳呼气末正压(best PEEP)的大小;应用Pearson法分析各时间点FRC和MP的相关性;应用受试者工作特征曲线(ROC)分析8 h FRC与MP对ARDS患者28 d病死率的预测价值。结果存活组与死亡组基线资料比较差异无统计学意义(P>0.05)。两组组内比较,存活组FRC 16 h、48 h与8 h相比,显著上升,而死亡组FRC明显下降;存活组MP、RR、best PEEP 16 h、48 h与8 h相比,显著下降,而死亡组均明显上升,差异有统计学意义(均P<0.05)。两组组间比较,存活组8 h、16 h与48 h FRC均高于死亡组;存活组MP、best PEEP均低于死亡组;两组治疗8 h RR比较,差异无统计学意义(P>0.05),存活组16 h和48 h的RR均显著低于死亡组,差异有统计学意义(P<0.05)。Pearson相关分析结果显示8 h、16 h、48 h FRC与MP呈正相关关系(r=0.598、0.730、0.786,P<0.05)。ROC曲线分析显示,8 h时FRC和MP预测ARDS患者28 d病死率的ROC曲线下面积分别为0.734和0.833(P<0.05),灵敏度分别为80.00%和83.33%,特异度分别为83.33%和66.67%。结论FRC和MP具有显著相关性,二者在一定程度上可作为预测ARDS患者28 d病死率的客观指标。
Objective To investigate the correlation between functional residual capacity(FRC)and mechanical power(MP)and evaluate their prognostic value for acute respiratory distress syndrome(ARDS)patients.Methods Totally 63patients diagnosed with ARDS and receiving invasive mechanical ventilation from the Department of Intensive Care Medicine,the First Affiliated Hospital of Jinzhou Medical University from November 2019 to December 2020 were selected.According to the prognosis on day 28,the patients were divided into survival group(n=39)and death group(n=24),and the FRC,MP,respiratory rate(RR)and the Best positive end-expiratory pressure(best PEEP)of the two groups were compared at 8 h,16 h and 48 h after mechanical ventilation treatment.The correlations of FRC with MP at each time point were analyzed by Pearson.Receiver operating curve(ROC)was used to analyze the predictive value of 8 h FRC and MP on28-day mortality of ARDS patients.Results There was no significant difference in baseline data between the survival group and the death group(P>0.05).For intra-group comparison,compared with 8 h,FRC in the survival group was significantly increased at 16 h and 48 h,and FRC in the death group was significantly decreased,with statistical significance(P<0.05);MP,RR and best PEEP at 16 h and 48 h were significantly decreased in the survival group,and significantly increased in the death group compared with those at 8 h,with statistical significance(P<0.05).For inter-group comparison,FRC of survival group at 8 h,16 h and 48 h was higher than that of death group,MP and best PEEP of survival group were lower than those of death group,the RR of survival group at 16 h and 48 h was significantly lower than that of the death group,with statistical significance(P<0.05);there was no significant difference in the RR at 8 h between the two groups(P>0.05).Pearson correlation analysis showed that FRC was positively correlated with MP at 8 h,16 h and 48 h(r=0.598、0.730、0.786,P<0.05).ROC curve analysis showed that FRC and MP at 8 h had good predictive value on 28-day mortality of ARDS patients,the area under ROC curve was 0.734 and 0.833(all P<0.05),the sensitivity was 80.00%and 83.33%,and the specificity was 83.33%and 66.67%,respectively.Conclusion FRC and MP are significantly correlated,which could be used as appropriate indicators to predict the 28-day mortality of ARDS patients.
作者
李晓东
李甜
张莉
刘敬禹
马艳梅
宋冰
胡占升
邸兴伟
LI Xiao-dong;LI Tian;ZHANG Li;LIU Jing-yu;MA Yan-mei;SONG Bing;HU Zhan-sheng;DI Xing-wei(Department of Critical Care Medicine,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,China)
出处
《中国实用内科杂志》
CSCD
北大核心
2023年第9期760-764,共5页
Chinese Journal of Practical Internal Medicine
基金
辽宁省科技厅重点研发项目(2020JH2/10100017)。
关键词
机械能
肺损伤
功能残气量
急性呼吸窘迫综合征
mechanical power
lung injury
functional residual capacity
acute respiratory distress syndrome
