动态监测氧合指数和降钙素原评估感染性休克合并急性呼吸窘迫综合征预后的应用价值
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摘要
目的探讨氧合指数(OI)和降钙素原(PCT)动态监测评估感染性休克并急性呼吸窘迫综合征(ARDS)预后的应用价值。方法回顾性分析82例感染性休克并ARDS患者的临床资料,根据患者28 d是否死亡分为死亡组39例和存活组43例。比较2组入院时、治疗24 h、48 h和72 h的OI与PCT水平,并分析两者对28 d死亡的预测价值。结果急性生理和慢性健康量表(APACHEⅡ)评分、序贯器官功能衰竭量表(SOFA)评分、血管外肺水指数(ELWI)与肺血管通透指数(PVPI)低于死亡组,差异均有统计学意义(P<0.05)。存活组入院时、治疗24 h、48 h及72 h的OI均高于死亡组,PCT均低于死亡组,差异均有统计学意义(P<0.05)。入院时、治疗24 h、48 h及72 h的OI和PCT对患者预后均有一定的预测价值(P<0.05),OI值以治疗72 h的预测价值为最高,而PCT以治疗48 h的预测价值为最高。结论 OI和PCT与感染性休克合并ARDS发病程度及肺功能密切相关,不同时间点的OI和PCT值预测价值不同,可酌情筛取最佳时间点提高预测效能。
Objective To explore the application value of dynamic oxygen index(OI) and procalcitonin(PCT), and to evaluate the prognosis of septic shock and acute respiratory distress syndrome(ARDS). Methods The data of 82 patients with septic shock and acute respiratory distress syndrome were analyzed retrospectively, and all the patients were divided into 2 groups according to the survival results in 28 days: 39 in death group and 43 in survival group. The OI and PCT levels before treatment at 24 h, 48 h, 72 h after treatment were compared between groups, and the application value with death consequence in 28 days was analyzed. Results The illness degree of the survival group was slighter than the death group, the APACHEⅡ score, SOFA sore, ELWI and PVPI of the death group were all lower than the death group, and the differences had statistical significance(P<0.05). The OI levels of the survival group before treatment at 24 h, 48 h, 72 h after treatment were all higher than the death group, while the PCT levels before treatment at 24 h, 48 h, 72 h after treatment were all lower than the dead group, and the differences had statistical significance(P<0.05). OI and PCT levels before treatment at 24 h, 48 h, 72 h after treatment all had predictive value for the prognosis of patients(P<0.05). The best application time of OI was 72 h, followed by 48 h, and the best application time of PCT was 48 h, followed by 24 h and 72 h. Conclusion OI and PCT are both closely related to the severity and lung function of septic shock combined with ARDS, and could predict the prognosis of the disease. The values of OI and PCT at different time points are different, and we could screen optimal time appropriately to improve the prediction efficiency.
Objective To explore the application value of dynamic oxygen index(OI) and procalcitonin(PCT), and to evaluate the prognosis of septic shock and acute respiratory distress syndrome(ARDS). Methods The data of 82 patients with septic shock and acute respiratory distress syndrome were analyzed retrospectively, and all the patients were divided into 2 groups according to the survival results in 28 days: 39 in death group and 43 in survival group. The OI and PCT levels before treatment at 24 h, 48 h, 72 h after treatment were compared between groups, and the application value with death consequence in 28 days was analyzed. Results The illness degree of the survival group was slighter than the death group, the APACHEⅡ score, SOFA sore, ELWI and PVPI of the death group were all lower than the death group, and the differences had statistical significance(P<0.05). The OI levels of the survival group before treatment at 24 h, 48 h, 72 h after treatment were all higher than the death group, while the PCT levels before treatment at 24 h, 48 h, 72 h after treatment were all lower than the dead group, and the differences had statistical significance(P<0.05). OI and PCT levels before treatment at 24 h, 48 h, 72 h after treatment all had predictive value for the prognosis of patients(P<0.05). The best application time of OI was 72 h, followed by 48 h, and the best application time of PCT was 48 h, followed by 24 h and 72 h. Conclusion OI and PCT are both closely related to the severity and lung function of septic shock combined with ARDS, and could predict the prognosis of the disease. The values of OI and PCT at different time points are different, and we could screen optimal time appropriately to improve the prediction efficiency.
引文
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[14] 朱婧,金洁,夏俊波,等.外周血白细胞分类和降钙素原水平对感染性休克患者预后的预测价值[J].中国卫生检验杂志,2017,27(16):2428-2430.
[15] 魏红艳,王亚娟,张丽,等.动态监测降钙素原及前白蛋白对于儿童重症细菌性肺炎的临床意义[J].临床和实验医学杂志,2018,17(11):1197-1200.
[2] Chen H,Wang S,Zhao Y,et al.Correlation analysis of omega-3 fatty acids and mortality of sepsis and sepsis-induced ARDS in adults:data from previous randomized controlled trials[J].Nutr J,2018,17(1):57.
[3] 段莉莉.感染性休克患者CRP/ALB比值对预测急性呼吸窘迫综合征的临床价值[J].标记免疫分析与临床,2016,23(6):630-632,647.
[4] 黄莉莉,缪华杰,陆洋,等.肺血管通透性指数和降钙素原与感染性休克相关的急性呼吸窘迫综合征的关系[J].上海交通大学学报:医学版,2018,38(5):547-551.
[5] 黄庆生,李燕,方明星,等.脉搏指示连续心排血量监测技术在感染性休克合并急性呼吸窘迫综合征患者中的应用研究[J].中华医院感染学杂志,2017,27(19):4371-4374.
[6] 黄伟.《第三版脓毒症与感染性休克定义国际共识》解读[J].中国实用内科杂志,2016,36(11):959-962.
[7] 中华医学会.急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)[J].中国实用外科杂志,2007,27(1):1-6.
[8] 杨毅.ARDS诊断——“柏林标准”的价值与意义[J].医学与哲学(B),2012,33(9):10-11,73.
[9] 高娅,王婷.降钙素原和C-反应蛋白在呼吸机相关性肺炎患者中的临床效果研究[J].中国卫生检验杂志,2018,28(10):1218-1219,1222.
[10] 刘志远.早期持续血液净化在严重脓毒症合并急性呼吸窘迫综合征患者治疗中的应用[J].中国全科医学,2017,20(S3):61-62.
[11] Kangelaris KN,Prakash A,Liu KD,et al.Increased expression of neutrophil-related genes in patients with early sepsis-induced ARDS[J].Am J Physiol Lung Cell Mol Physiol,2015,308(11):L1102-L1113.
[12] 吕雪.重症监护室感染性休克患者预后死亡的危险因素分析[J].中国卫生统计,2015,32(5):803-804,807.
[13] 白玉龙,宁宗,王威,等.感染性休克患者死亡的危险因素分析[J].微创医学,2016,11(1):18-20.
[14] 朱婧,金洁,夏俊波,等.外周血白细胞分类和降钙素原水平对感染性休克患者预后的预测价值[J].中国卫生检验杂志,2017,27(16):2428-2430.
[15] 魏红艳,王亚娟,张丽,等.动态监测降钙素原及前白蛋白对于儿童重症细菌性肺炎的临床意义[J].临床和实验医学杂志,2018,17(11):1197-1200.