中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

ICU 重症肺炎患者进展为急性呼吸窘迫综合征的危险因素分析

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目的探究重症加强治疗病房(ICU)重症肺炎患者进展为急性呼吸窘迫综合征(ARDS)的早期危险因素。方法回顾性分析 ICU 收治的 80 例重症肺炎患者资料。基于 2011 年柏林诊断标准,根据治疗期间的血气结果及影像学检查,将其分为 ARDS 组和非 ARDS 组,分别收集两组患者的年龄、性别、体重及治疗期间的急性生理学和慢性健康状况评分系统Ⅱ评分、乳酸、肺炎严重程度评分(PSI)、肺损伤预测评分(LIPS)、感染相关指标、基础疾病等共 17 项指标。采用单因素分析法进行比较后,将有统计学意义的变量纳入多因素 logistic 回归分析。绘制受试者工作特征(ROC)曲线,评估各指标对于其进展为 ARDS 的预测价值。结果80 例重症肺炎患者中 40 例进展为 ARDS,其中轻中度 ARDS 4 例,重度 ARDS 36 例。单因素分析结果示:降钙素原(t=4.08,P<0.001)、PSI 评分(t=10.67,P<0.001)、LIPS 评分(t=5.14,P<0.001)、休克(χ2=11.11,P<0.001)、白蛋白水平(t=3.34,P=0.001)5 项指标与重症肺炎后 ARDS 的发生有关。进一步多因素 logistic 回归分析结果示:PSI 评分[优势比(OR)=0.854,95% 可信区间(95%CI)=132.2~145.5,P=0.01]、LIPS 评分(OR=0.23,95%CI=4.62~5.53,P=0.01)为重症肺炎后 ARDS 发生的独立危险因素。ROC 曲线下面积(AUC)显示,PSI、LIPS 评分对于重症肺炎后 ARDS 的发生有较大的早期预测价值,PSI 的 AUC 为 0.947,截断值为 150.5 分;LIPS 的 AUC 为 0.901,截断值为 7.2 分。PSI 评分≥150.5 分时其敏感性为 87.5%,特异性为 90.0%;LIPS 评分≥7.2 分时敏感性为 85.0%,特异性为 85.0%。结论PSI、LIPS 评分是重症肺炎患者进展为 ARDS 的高危因素,其评分值可以为识别高危患者提供参考,指导临床医师早期制定相应诊疗方案。

ObjectiveTo discuss the risk factors of acute respiratory distress syndrome (ARDS) in patients with severe pneumonia.MethodsData of 80 patients with severe pneumonia admitted in our ICU were analyzed retrospectively, and they were divided into two groups according to development of ARDS, which was defined according to the Berlin new definition. The age, gender, weight, Acute Physiology and Chronic Health EvaluationⅡscore, lactate, PSI score and LIPS score, etc. were collected. Statistical significance results were evaluated by multivariate logistic regression analysis after univariate analysis. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of the parameter for ARDS after severe pneumonia.ResultsForty patients with severe pneumonia progressed to ARDS, there were 4 moderate cases and 36 severe cases according to diagnostic criteria. Univariate analysis showed that procalcitonin (t=4.08, P<0.001), PSI score (t=10.67, P<0.001), LIPS score (t=5.14, P<0.001), shock (χ2=11.11, P<0.001), albumin level (t=3.34, P=0.001) were related to ARDS. Multivariate logistic regression analysis showed that LIPS [odds ratio (OR) 0.226, 95%CI=4.62-5.53, P=0.013] and PSI (OR=0.854, 95%CI=132.2-145.5, P=0.014) were independent risk factors for ARDS. The predictive value of LIPS and PSI in ARDS occurrence was significant. The area under ROC curve (AUC) of LIPS was 0.901, the cut-off value was 7.2, when LIPS ≥7.2, the sensitivity and specificity were both 85.0%. AUC of PSI was 0.947, the cut-off value was 150.5, when PSI score ≥150.5, the sensitivity and specificity were 87.5% and 90.0% respectively.ConclusionsPSI and LIPS are independent risk factors of ARDS in patients with severe pneumonia, which may be references for guiding clinicians to make an early diagnosis and treatment plan.

关键词: 重症肺炎; 急性呼吸窘迫综合征; 肺损伤预测评分; 肺炎严重程度评分; 危险因素

Key words: Severe pneumonia; Acute respiratory distress syndrome; Lung injury prediction score; Pneumonia severity index score; Risk factor

引用本文: 赵晶晶, 周小妹, 姚莉. ICU 重症肺炎患者进展为急性呼吸窘迫综合征的危险因素分析. 中国呼吸与危重监护杂志, 2018, 17(6): 561-564. doi: 10.7507/1671-6205.201801035 复制

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