摘要
目的探讨中心静脉-动脉血二氧化碳分压差(GAP)动态变化结合三尖瓣瓣环位移(TAPSE)在脓毒症合并急性呼吸窘迫综合征(ARDS)患者病情评估及预后评价中的作用,以期对疾病的治疗提供依据。方法回顾性分析重症医学科病历资料完整的脓毒症合并ARDS患者113例,按28 d预后分为生存组及死亡组。所有患者均计算同期的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和序贯器官衰竭评分(SOFA);观察两组患者ΔGAP与TAPSE变化,记录入科时,6、24 h相关的TAPSE值对各个节点进行比较,同时记录相关的GAP值,计算6、24 h的动态变化的绝对值对各个节点进行比较,同时对相关节点的记录值绘制受试者工作特征曲线(ROC)评价各指标对预后的价值。结果共入选113例脓毒症合并ARDS患者,28 d存活59例,生存率为52.21%;死亡54例,病死率为47.79%。死亡组除入ICU时APACHEⅡ、SOFA评分均明显高于存活组,ICU住院时间明显短于存活组(P<0.05)外,其他临床特征比较差异均无统计学意义(P>0.05)。死亡组与存活组入ICU 0、6 h时,TAPSE值差异有统计学意义(P<0.05),其中入ICU 0、6、24 h时ROC曲线下面积分别为0.791、0.835、0.614。6 h后的GAP变化值Δh1与24 h后的GAP变化值Δh2差异有统计学意义(P<0.05),ROC曲线下面积分别为0.757、0.713。其中6 h时,TAPSE的截断值取13.19 mm时ROC曲线下面积为0.835,为单指标最高,预测敏感度特异度分别为73.95%、95.21%;其入ICU 6 h的TAPSE结合ΔGAP的ROC曲线下面积最高为0.863;其截断点取0.495时,预后评价的敏感度为86.25%,特异度为91.59%。结论早期的TAPSE可作为脓毒症合并ARDS的预后评价新的重要指标,结合GAP的动态变化可为早期脓毒症合并ARDS患者的病情进行评估,并可预测患者的预后,同时针对高危患者进行干预治疗提供重要参考。
Objective To investigete the effect of dynamic changes of GAP combined with tricuspid annulus plane systolic excursion ( TAPSE) on the assessment of disease and prognosis of patients with sepsis combined with acute respiratory distress syndrome ( ARDS). Methods A retrospective analysis of 113 patients with sepsis - associated ARDS were divided into survival group and death group according to the prognosis on the Day 28. APACHE Ⅱ and SOFA scores were calculated. The changes of ΔGAP and TAPSE in both groups were observed and recorded. In 6 h,the relative TAPSE values were compared after 24 h,and the related GAP values were recorded. The absolute values of the dynamic changes after 6 h and 24 h were compared,while recorded values were plotted in receiver operating characteristic curve ( ROC) to assess the value of each indicator for prognosis. Results In 113 enrolled sepsis patients,59 patients survived on the Day 28,with survival rate of 52. 21%. There were 54 deaths and the mortality rate was 47. 79%. The blood lactic acid,APACHEⅡ and SOFA scores of the death group were significantly higher than those in survivors,and the length of stay in ICU was significantly shorter than that of survivors ( P < 0. 05). There were significant differences in TAPSE values between death group and survivors at ICU 0 h,6 h and 24 h,and the areas under the ROC curve were 0. 791,0. 835 and 0. 614,respectively. The GAP change value Δh1 ( at 6 h) were significantly differed from the Δh2 at 24 h at ICU,as the area under the ROC were 0. 757 and 0. 713,respectively. The area under ROC curve of TAPSE with the cut - off value of 13. 19 mm at 6 h was the highest,with the predictive sensitivity and specificity of 73. 95% and 95. 21%,respectively. The area under ROC curve of TAPSE and ΔGAP was the highest ( 0. 863),with the cut - off point of 0. 495,and the sen- sitivity and specificity were 86. 25% and 91. 59%,respectively. Conclusion Early TAPSE can be used as a new predic- tor of sepsis prognosis. Combined with the early dynamic chang
作者
杨宵曼
常银江
魏桂芳
杜玉明
YANG Xiao - man;CHANG Yin - jiang;WEI Gui - fang;DU Yu - ming(Department of Critical Care Medicine,Puyang People's Hospital,Puyang 457000,Henan,China)
出处
《广东医学》
CAS
2019年第10期1433-1438,共6页
Guangdong Medical Journal
基金
河南省医学科技攻关计划项目(编号:201303069)
