摘要
目的 探究重症监护室(ICU)急性呼吸衰竭患者外周血超敏C反应蛋白与白蛋白比值(HCAR)、诱骗受体3(DcR3)、水通道蛋白-5(AQP-5)水平与机械通气撤机结局的关系及临床价值。方法 选取连云港市第二人民医院2018年8月—2021年8月ICU急性呼吸衰竭患者120例,均行机械通气治疗,在符合自主呼吸试验(SBT)指征且通过30 min SBT后撤机,根据撤机后48 h内是否再插管分为撤机成功组(87例)和撤机失败组(33例),撤机前采集外周血检测HCAR、DcR3、AQP-5水平,分析外周血HCAR、DcR3、AQP-5水平与撤机结局的关系及预测价值。结果 两组呼吸衰竭类型、合并器官功能障碍综合征(MODS)、肺部超声评分(LUS)、急性生理与慢性健康评价系统Ⅱ(APACHEⅡ)评分差异有统计学意义(P<0.05);撤机失败组外周血HCAR、DcR3高于撤机成功组,AQP-5低于撤机成功组(P<0.05);Pearson相关性分析显示外周血HCAR、DcR3与LUS、APACHEⅡ评分呈正相关,AQP-5与LUS、APACHEⅡ评分呈负相关(P<0.05);单因素、多因素分析均显示,外周血HCAR、DcR3、AQP-5影响撤机结局(P<0.05);外周血HCAR、DcR3、AQP-5预测撤机失败的截断值分别为4.10 mg/g、14.55μg/L、7.91μg/L,联合预测撤机失败的曲线下面积(AUC)为0.915(95%CI:0.850~0.958),大于各指标单独预测;以截断值为界分为低水平与高水平,外周血HCAR、DcR3高水平患者30 d生存率低于低水平患者,外周血AQP-5高水平患者30 d生存率高于低水平患者(P<0.05)。结论 ICU急性呼吸衰竭患者外周血HCAR、DcR3、AQP-5水平与撤机结局密切相关,联合检测可作为预测撤机失败的重要辅助手段,还能帮助临床判断死亡风险,为临床提供可靠的数据支持。
Objective To investigate the relationship between peripheral blood high-sensitivity C-reactive protein to albumin ratio(HCAR),decoy receptor 3(DcR3)and aquaporin-5(AQP-5)levels in patients with acute respiratory failure in intensive care unit(ICU).Relationship and clinical value of mechanical ventilation weaning outcomes.Methods A total of 120 patients with acute respiratory failure in the ICU of our hospital from August 2018 to August 2021 were selected,and all of them received mechanical ventilation.Whether re-intubation within 48 hours was divided into a successful weaning group(87 cases)and a weaning failure group(33 cases).Association and predictive value of AQP-5 levels with weaning outcomes.Results There were significant differences in respiratory failure type,combined MODS,LUS and APACHE II scores between the two groups(P<0.05);Pearson correlation analysis showed that peripheral blood HCAR and DcR3 were positively correlated with LUS and APACHEⅡscores,and AQP-5 was negatively correlated with LUS and APACHEⅡscores(P<0.05).Univariate and multivariate analysis showed that,Peripheral blood HCAR,DcR3,and AQP-5 were significantly correlated with the weaning outcome(P<0.05);the cutoff values of peripheral blood HCAR,DcR3,and AQP-5 for predicting weaning failure were 4.10 mg/g,14.55 ng/mL,and 7.91μg/L,respectively.The AUC of combined prediction of weaning failure was 0.915(95%CI:0.850-0.958),which was greater than the individual predictions of each index;the cutoff value was divided into low-level and high-level patients,and patients with high levels of HCAR and DcR3 in peripheral blood The 30-day survival rate was lower than that of patients with low level,and the 30-day survival rate of patients with high level of peripheral blood AQP-5 was higher than that of patients with low level(P<0.05).Conclusion The levels of HCAR,DcR3 and AQP-5 in peripheral blood of patients with acute respiratory failure in ICU are closely related to the outcome of weaning.Combined detection can be used as an important auxiliary
作者
程亚娟
乔莉
CHENG Yajuan;QIAO Li(The Second People's Hospital of Lianyungang,Lianyungang Jiangsu 222000,China)
出处
《中国急救复苏与灾害医学杂志》
2024年第1期51-55,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
江苏省优势学科建设工程项目(编号:YSHL0813-44)。
关键词
重症监护室
急性呼吸衰竭
机械通气
超敏C反应蛋白与白蛋白比值
诱骗受体3
水通道蛋白-5
撤机结局
Intensive care unit
Acute respiratory failure
Mechanical ventilation
High-sensitivity C-reactive protein to albumin ratio
Decoy receptor 3
Aquaporin-5
Weaning outcome
