摘要
目的探讨迷你营养评估简表(mini nutritional assessment short-form,MNA-SF)联合国家早期预警评分(national early warning score,NEWS)对脓毒症急性呼吸窘迫综合征预后的影响。方法选取南京中医药大学附属南京市中西医结合医院2017年1月至2021年1月收治的脓毒症急性呼吸窘迫综合征患者150例作为研究对象。入院后监测患者生命体征,一般资料,记录基础疾病、体质量指数(body mass index,BMI),呼吸机参数,机械通气时间,入住ICU时间,血生化,血气分析,降钙素原(procalcitonin,PCT),去甲肾上腺素(noradrenaline,NE)最大剂量,并进行MNA-SF和NEWS评分,随访患者28天死亡率。根据患者28天生存情况分为存活组91例,死亡组59例,比较两组患者PCT、CRP、PH值、乳酸、平台压(plateau pressure,Pplat)、呼气末正压(positive end expiratory pressure,PEEP)、机械通气时间、入住ICU时间、MNA-SF和NEWS评分差异。采用二分类Logistic回归模型和ROC曲线下面积来评估MNA-SF和NEWS评分及两者联合评分对脓毒症急性呼吸窘迫综合征患者预后的预测价值。分析MNA-SF、NEWS评分与呼吸衰竭患者预后指标包括乳酸、平台压、机械通气时间的相关性。结果MNA-SF、NEWS及联合评分对患者预后均有较高的价值(AUC=0.796、0.799、0.860),联合评分的价值较单独评分系统更高(联合评分vs MNA-SF,Z=4.568>1.96,P<0.001;联合评分vs NEWS,Z=4.447>1.96,P<0.001,预测死亡风险的灵敏度和特异度分别为89.6%和81.1%)。另外,MNA-SF评分与患者乳酸、平台压、机械通气时间,具有良好的负相关性(r=-0.38、-0.30、-0.33,P均<0.01),而NEWS评分具有良好的正相关性(r=0.36、0.42、0.38,P均<0.001)。结论MNA-SF和NEWS评分,对脓毒症急性呼吸窘迫综合征患者预后均有较高的预测价值,两者联合优于单项评分。
Objective To explore the effect of mini nutritional assessment short-form(MNA-SF)combined with national early warning score(NEWS)on the prognosis of sepsis acute respiratory distress syndrome(ARDS).Methods 150 patients with septic ARDS treated in Nanjing integrated traditional Chinese and western medicine Hospital Affiliated with Nanjing University of Chinese Medicine from January 2017 to January 2021 were selected as the research objects.After admission,the vital signs,general clinical data,basic diseases,body mass index(BMI),ventilator parameters,mechanical ventilation time,ICU stay time,blood biochemistry,blood gas analysis procalcitonin(PCT),andthe maximum dose of noradrenaline(NE)was recorded.The scores of MNA-SF and NEWS were performed,and the mortality of patients was followed up for 28 days.According to the 28-day survival of the patients,they were divided into 91 cases in the survival group and 59 cases in the death group.The PCT,CRP,PH value,lactic acid,plateau pressure(Pplat),positive end-expiratory pressure(PEEP),mechanical ventilation time,ICU stay time,and MNA-SF and NEWS score differenceswere compared between the two groups.A binary logistic regression model and the area under the ROC curve were used to evaluate the predictive value of MNA-SF and NEWS scores and their combined scores on the prognosis of patients with septic ARDS.The correlation between MNA-SF,NEWS score,and the prognosis indexes of patients with respiratory failure,including lactic acid,plateau pressure,mechanical ventilation time were analyzed.Results MNA-SF,NEWS,and combined scores had higher values for the prognosis of patients(AUC=0.796,0.799,0.860,respectively),and the value of combined scores was higher than that of a single scoring system(combined score vs.MNA-SF,Z=4.568>1.96,P<0.001;combined score vs.NEWS,Z=4.447>1.96,P<0.001,the sensitivity and specificity of predicting the risk of death were 89.6%and 81.1%,respectively).In addition,the MNA-SF score was negativelycorrelated withthe patient's lactate,plateau pressure,and me
作者
高戎
杨润华
刘欣
林浩
GAO Rong;YANG Run-hua;LIU xin;Lin Hao(Department of Emergency and Intensive Care Medicine,Nanjing integrated traditional Chinese and western medicine Hospital Affiliated with Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210014,China)
出处
《临床肺科杂志》
2022年第3期380-384,共5页
Journal of Clinical Pulmonary Medicine
