摘要
目的探讨病毒性肺炎所致急性呼吸窘迫综合征(ARDS)患者实施气管插管机械通气(ETI-MV)的影响因素,为个体化选择提供依据。方法回顾性分析2017年11月至2022年3月新疆医科大学第一附属医院呼吸重症监护病房(RICU)收治的病毒性肺炎所致ARDS患者。收集患者的性别、年龄、伴随疾病、并发症、临床症状和体征、辅助检查数据、ARDS严重程度、感染病毒种类、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、呼吸支持方式及预后相关指标,对各因素进行单因素分析,将单因素分析中有统计学意义的变量进行多因素Logistic回归分析。绘制受试者工作特征曲线(ROC曲线),评估各指标对实施ETI-MV的预测价值。结果共117例患者纳入研究,其中ETI-MV组61例,轻度、中度和重度患者ARDS分别为3例(4.9%)、39例(63.9%)和19例(31.1%);非ETI-MV组56例,轻度、中度和重度患者ARDS分别为16例(28.6%)、38例(67.8%)和2例(3.6%),两组间比较差异有统计学意义(P<0.05)。单因素分析显示,ETI-MV组与非ETI-MV组入RICU 24 h白细胞介素-6(IL-6)水平(ng/L:104.0±90.0比62.4±76.0)、氧合指数〔PaO_(2)/FiO_(2)(mmHg,1 mmHg≈0.133 kPa):123.9±30.9比173.6±28.5〕、肺部浸润性阴影分布范围≥3/4肺野的病例占比〔85.3%(52/61)比21.5%(12/56)〕、APACHEⅡ评分≥16.5分〔67.2%(41/61)比42.9%(24/56)〕、院内侵袭性曲霉菌感染占比〔14.8%(9/61)比3.6%(2/56)〕、院内细菌感染占比〔16.4%(10/61)比3.6%(2/56)〕以及病程中最低CD4+T淋巴细胞计数(个/mm^(3):192.2±35.8比215.0±58.3)比较差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,入RICU 24 h肺部浸润性阴影分布范围≥3/4肺野〔优势比(OR)=12.527,95%可信区间(95%CI)为3.279~47.859,P<0.001〕、APACHEⅡ评分≥16.5分(OR=30.604,95%CI为4.318~216.932,P=0.001)、PaO_(2)/FiO_(2)(OR=0.948,95%CI为0.925~0.972,P<0.001)、CD4^(+)T淋巴细胞计数(OR=0.975,95%CI为0.955~0.995,P=0.015)以及院�
Objective To investigate the influencing factors of endotracheal intubation and mechanical ventilation(ETI-MV)in patients with acute respiratory distress syndrome(ARDS)caused by viral pneumonia,and to provide evidence for individualized use of ETI-MV.Methods Patients with ARDS due to viral pneumonia admitted to the respiratory intensive care unit(RICU)of the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed from November 2017 to March 2022.The gender,age,concomitant diseases,clinical symptoms and signs,complications,lab results,ARDS severity,infectious virus type,acute physiology and chronic health evaluationⅡ(APACHEⅡ),respiratory support methods and prognosis-related variables were collected.Univariate analysis was performed on each factor,and the variables with statistical significance in the univariate analysis were subjected multivariate logistic regression analysis.The receiver operating characteristic curve(ROC curve)was drawn to evaluate the predictive value of each index for the implementation of ETI-MV.Results A total of 117 patients were enrolled in the study,including 61 patients in the ETI-MV group,and 3 patients(4.9%),39 patients(63.9%)and 19 patients(31.1%)with mild,moderate and severe ARDS,respectively.There were 56 patients in non-ETI-MV group,and the mild,moderate and severe ARDS cases were 16 cases(28.6%),38 cases(67.8%)and 2 cases(3.6%),respectively.There was significant difference between the two groups(P<0.05).Univariate analysis showed that during 24 hours admitted to RICU,the levels of interleukin-6[IL-6(ng/L):104.0±90.0 vs.62.4±76.0],oxygenation index[PaO_(2)/FiO_(2)(mmHg,1 mmHg≈0.133 kPa):123.9±30.9 vs.173.6±28.5],the proportion of cases with pulmonary infiltrating opacity distribution range≥3/4 lung fields[85.3%(52/61)vs.21.5%(12/56)],APACHEⅡscore≥16.5[67.2%(41/61)vs.42.9%(24/56)],the rate of nosocomial invasive aspergillus infection[14.8%(9/61)vs.3.6%(2/56)],the percentage of nosocomial bacterial infection[16.4%(10/61)vs.3.6%(2/56)],a
作者
康蒙
李婧文
万秋风
罗茜
贾文婷
杨婷
胡鑫莹
谷兴丽
徐思成
Kang Meng;Li Jingwen;Wan Qiufeng;Luo Xi;Jia Wenting;Yang Ting;Hu Xinying;Gu Xingli;Xu Sicheng(Respiratory Intensive Care Unit,Pulmonary and Critical Care Medical Center,the First Affiliated Hospital of Xinjiang Medical University,Urmqi 830054,Xinjiang Uygur Autonomous Region,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2022年第6期586-591,共6页
Chinese Critical Care Medicine
基金
新疆维吾尔自治区临床重点专科建设项目(2016-56)。
关键词
病毒性肺炎
急性呼吸窘迫综合征
机械通气
气管插管
Viral pneumonia
Acute respiratory distress syndrome
Mechanical ventilation
Endotracheal intubation
