摘要
目的探索新型综合呼吸力学参数弹力功(elastic power,EP)与急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者28 d预后相关性。方法依次纳入自2018年6月至2022年6月在连云港市三家医院5个重症监护病房住院进行有创机械通气至少48 h的ARDS患者,收集其基线资料及呼吸力学参数。根据相应公式计算出弹力功、机械功、驱动压及肺顺应性。采用COX多因素回归法进行ARDS患者28 d死亡风险因素分析,并根据ROC曲线分析及Kaplan-Meier生存曲线,评价肺顺应性标化的弹力功(elastic power/compliance,EP/cst)对ARDS患者28 d预后的预测价值。结果ARDS存活组与死亡组组间潮气量、PEEP设置比较差异无统计学意义(P>0.05),而两组间呼吸频率、平台压力、驱动压、肺顺应性、机械功、弹力功以及EP/cst、MP/cst比较差异有统计学意义(均P<0.01)。多因素COX回归分析显示:EP/cst(HR=1.211,95%CI:1.091~1.323)以及呼吸频率(HR=1.209,95%CI:1.046~1.339)与ARDS更严重的病情程度以及更差的预后密切相关,高Cst-EP组28 d累积生存率明显低于低Cst-EP组(50.00%vs.84.10%,P<0.01)。结论弹力功及肺顺应性标化的新型组合指标EP/Cst可用于ARDS病情严重程度评估,对患者28 d预后有较好的预测效能。
Objective To explore the relevance of a new comprehensive respiratory mechanics parameter,elastic power,to the 28-day prognosis of ARDS patients.Methods Patients with ARDS hospitalized for at least 48 h with invasive mechanical ventilation in five intensive care units in three local hospitals in Lianyungang City from June 2018 to June 2022 were included in the study.Their baseline data and respiratory mechanics parameters were collected.Elastic power,mechanical power,driving pressure and lung compliance are calculated according to the corresponding formulae.The prognostic risk factors of ARDS patients were analysed using COX multi-factor regression,and the predictive value of EP/Cst on the 28-day prognosis of ARDS patients was evaluated based on ROC curve analysis and Kaplan-Meier survival curve.Results There was no significantly difference in tidal volume and PEEP settings between the patients in the ARDS survivor and death groups(P>0.05).However,the differences in respiratory rate,plateau pressure,driving pressure,lung compliance,mechanical work,elastic work,EP/cst and MP/cst between the two groups were significantly different(all P<0.01).Multifactorial COX regression analysis showed that EP/cst(HR=1.211,95%CI:1.091-1.323)and RR(HR=1.209,95%CI:1.046-1.339)were strongly associated with a more severe degree of illness and a worse prognosis in ARDS.And the cumulative survival rate at 28 d was significantly lower in the high Cst-EP group than in the low Cst-EP group(50.00%vs.82.40%,P<0.01).Conclusions The new respiratory mechanics parameters EP and EP/Cst can assess the severity of ARDS with a good predictive effect on patient prognosis at 28 days.
作者
谢永鹏
姚喜庆
任盼盼
颜瑶
华明
谷小宝
王言理
李小民
Xie Yongpeng;Yao Xiqing;Ren Panpan;Yan Yao;Hua Ming;Gu Xiaobao;Wang Yan;Li Xiaomin(Department of Emergency and Critical Care Medicine,The first people's hospital of Lianyungang city.Lianyungang 222000,China;The first people's hospital of Lianyungang city,Lianyungang 222000,China;The first people's hospital of Guannan county,Lianyungang 222000,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2023年第10期1397-1404,共8页
Chinese Journal of Emergency Medicine
基金
江苏省科技厅社会发展面上项目(BE2020670)
江苏省卫生健康委科研项目(H2019109)
江苏省连云港市科技局社发项目(SF2117)。
