摘要
目的探讨肺部超声对急诊尿毒症性急性肺水肿患者无创正压通气(non-invasive positive pressure ventilation,NPPV)治疗失败的预测价值.方法回顾性分析广州医科大学附属第二医院急诊科NPPV治疗尿毒症性急性肺水肿患者的临床资料.根据临床结局,分成NPPV治疗成功组和NPPV治疗失败组,采用Logistic回归分析评估NPPV治疗失败的危险因素,并通过受试者工作特征(ROC)曲线评价各种危险因素预测NPPV治疗失败的效能.结果共纳入69例行NPPV治疗的尿毒症性急性肺水肿患者,NPPV治疗成功组50例(67.8%),NPPV治疗失败组19例(32.2%).与NPPV治疗成功组比较,NPPV治疗失败组的肺部超声评分[分:19(17,19)vs.25(24,29),P=0.000]、重力依赖区出现实变的比例(%:38.0 vs.78.9,P=0.003)、降钙素原(PCT)(ng/mL:0.88±0.87 vs.1.81±1.63,P=0.003)、血白蛋白(Alb)(g/L:35.0±4.9 vs.32.0±5.2,P=0.02)和急性生理与慢性健康状况Ⅱ评分(APACHEⅡ评分)(分:19.6±4.0 vs.23.3±4.3,P=0.001)差异均有统计学意义(P<0.05).肺部超声评分、PCT和APACHEⅡ评分的ROC曲线下面积(AUC)分别是0.821、0.744和0.752.经多因素Logistic回归分析显示肺部超声评分(OR=2.512,P=0.00)、APACHEⅡ评分(OR=1.327,P=0.03)是NPPV治疗失败的独立危险因素.结论肺部超声对急诊尿毒症性急性肺水肿患者的NPPV疗效有较好的评估价值.
Objective To evaluate the value of lung ultrasound for the chronic dialysis patients of acute pulmonary edema with non-invasive positive ventilation(NPPV)treatment admitted into emergency department.Methods The chronic dialysis patients of acute pulmonary edema treated with NPPV and underwent lung ultrasound examination were retrospectively analyzed.According to the results of NPPV treatment,the patients were divided into NPPV success group and NPPV failure group.All of the lung ultrasound parameters and the clinical data were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to screen out the risk factors by taking the failure of NPPV treatment as the dependent variable.The area under the receiver operating characteristic(ROC)curve was used to analyze the predictive value of the above indicators.Results Atotalof69 chronic dialysis patients of acute pulmonary edema included 50 cases(67.8%)of NPPV success and 19 cases(32.2%)of NPPV failure,revealed by lung ultrasound.In comparison with the NPPV success group,the lung ultrasound score[scores:19(17,19)vs.25(24,29),P=0.000],the ratio of lung consolidation(38.0%vs.78.9%,P=0.003),the level of procalcitonin(PCT,ng/mL;0.88±0.87 vs.1.81±1.63,P=0.003),and the APACHE II score(scores:19.6±4.0 vs.23.3±4.3,P=0.001)were significantly higher and serum albumin level(g/L:35.0±4.9 vs.32.0±5.2,P=0.02)was significantly lower in NPPV failure group(all P<0.05).The AUCs of lung ultrasound score,PCT and APACHE I score for predicting NPPV failure were 0.821,0.744 and 0.752,respectively.Multivariate Logistic regression analysis showed lung ultrasound score(OR=2.512,P=0.00)and APACHE I score(OR=1.327,P=0.03)were independent predictors of NPPV failure.Conclusion The lung ultrasound could provide predictive values for the NPPV failure in the chronic dialysis patients with acute pulmonary edema admitted to emergency department.
作者
朱永城
江慧琳
伍卓文
冯雪珍
林珮仪
Zhu Yong-cheng;Jiang Hui-lin;Wu Zhuo-wen;Feng Xue-zhen;Lin Pei-yi(Department of Emergency,the Second Affliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2020年第8期715-718,共4页
Chinese Journal of Critical Care Medicine
基金
广东省医学科研基金(A2019183)
广州市医学重点学科建设项目(2017-2019)。
关键词
尿毒症
肺水肿
无创正压通气(NPPV)
肺部超声
End-stage renal disease
Pulmonary edema
Non-invasive positive ventilation(NPPV)
Lung ultrasound
