血红蛋白水平及动态变化对慢性阻塞性肺疾病急性加重期有创机械通气患者的短期预后预测价值
摘要
目的:观察慢性阻塞性肺疾病急性加重期(AECOPD)有创机械通气患者血红蛋白的变化及其对患者短期预后的预测价值。方法:采用前瞻性观察性方法,收集110例AECOPD行有创机械通气(IMV)患者的临床资料,在入ICU的第1、3、5、7天(D_1、D_3、D_5、D_7)记录血红蛋白(Hb),入ICU后90 d患者生存状态为观察终点,使用受试者工作曲线下面积(AUC)评价Hb及其变化值(HbΔ)预测患者预后的价值。结果:贫血组病死率明显高于非贫血组,差异有统计学意义(P<0.001)。Hb D_1,Hb D_3, Hb D_5,Hb D_7的预测患者短期预后的AUC分别是0.774(95%:0.684～0.848)、0.794(95%:0.707～0.865)、0.803(95%:0.716～0.873)、0.838(95%:0.755～0.901)。HbΔD3-1,HbΔD5-1,HbΔD7-1的AUC分别是0.499 (95%:0.387～0.611)、0.435 (95%:0.317～0.553)、0.363 (95%:0.253～0.473)。结论:AECOPD行IMV患者贫血发病率较高,入ICU 7 d内的Hb均可以预测患者的短期预后,但是7 d内的Hb变化值不能预测患者的预后。
引文
[1] Toft-Petersen A P,Torp-Pedersen C,Weinreich U M,et al.Association between hemoglobin and prognosis in patients admitted to hospital for COPD[J].Int J Chron Obstruct Pulmon Dis,2016,11(1):2813.
[2] Vasquez A,Logomarsino J V.Anemia in Chronic Obstructive Pulmonary Disease and the Potential Role of Iron Deficiency[J].COPD,2015,13(1):100.
[3] Boutou A K,Hopkinson N S,Polkey M I.Anaemia in chronic obstructive pulmonary disease:an insight into its prevalence and pathophysiology[J].Clin Sci(Long),2015,128(5):283.
[4] Osadnik CR,Tee VS,Carson-Chahhoud KV,et al.Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease[J].Cochrane Database Syst Rev,2017,7:CD004104.
[5] Rasmussen L,Christensen S,Lenlerpetersen P,et al.Anemia and 90-day mortality in COPD patients requiring invasive mechanical ventilation[J].Clin Epidemiol,2011,3(1):1.
[6] Gadre S K,Jhand A S,Abuqayyas S,et al.Effect of Anemia on Mortality in Mechanically Ventilated Patients With Chronic Obstructive Pulmonary Disease[J].J Intensive Care Med,2017,885066617739561.
[7] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255.
[8] Sarkar M,Rajta P N,Khatana J.Anemia in Chronic obstructive pulmonary disease:Prevalence,pathogenesis,and potential impact[J].Lung India,2015,32(2):142.
[9] Vogelmeier C F,Criner G J,Martinez F J,et al.Global Strategy for the Diagnosis,Management,and Prevention of Chronic Obstructive Lung Disease 2017 Report:GOLD Executive Summary[J].Am J Respir Crit Care Med,2017,195(5):557.
[10] Portillo K,Martinez-Rivera C,Ruiz-Manzano J.Anaemia in chronic obstructive pulmonary disease.Does it really matter?[J].Int J Clin Pract,2013,67(6):558.
[11] 梁世廉.慢性阻塞性肺疾病贫血的研究进展[J].临床肺科杂志,2015(12):2286.
[12] 王美平,姜利,朱波,等.机械通气患者贫血的临床观察研究[J].中华危重病急救医学,2012,24(2):70.
[13] Berkius J,Sundh J,Nilholm L,et al.What determines immediate use of invasive ventilation in patients with COPD?[J].Acta Anaesthesiol Scand,2013,57(3):312.
[14] 杨静,赵珂,王大庆.慢性阻塞性肺疾病急性加重期患者有创机械通气脱机困难相关危险因素分析[J].吉林医学,2018,39(1):42.
[15] Silverberg D S,Mor R,Weu M T,et al.Anemia and iron deficiency in COPD patients:prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron[J].BMC Pulm Med,2014,14(1):1.
[2] Vasquez A,Logomarsino J V.Anemia in Chronic Obstructive Pulmonary Disease and the Potential Role of Iron Deficiency[J].COPD,2015,13(1):100.
[3] Boutou A K,Hopkinson N S,Polkey M I.Anaemia in chronic obstructive pulmonary disease:an insight into its prevalence and pathophysiology[J].Clin Sci(Long),2015,128(5):283.
[4] Osadnik CR,Tee VS,Carson-Chahhoud KV,et al.Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease[J].Cochrane Database Syst Rev,2017,7:CD004104.
[5] Rasmussen L,Christensen S,Lenlerpetersen P,et al.Anemia and 90-day mortality in COPD patients requiring invasive mechanical ventilation[J].Clin Epidemiol,2011,3(1):1.
[6] Gadre S K,Jhand A S,Abuqayyas S,et al.Effect of Anemia on Mortality in Mechanically Ventilated Patients With Chronic Obstructive Pulmonary Disease[J].J Intensive Care Med,2017,885066617739561.
[7] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255.
[8] Sarkar M,Rajta P N,Khatana J.Anemia in Chronic obstructive pulmonary disease:Prevalence,pathogenesis,and potential impact[J].Lung India,2015,32(2):142.
[9] Vogelmeier C F,Criner G J,Martinez F J,et al.Global Strategy for the Diagnosis,Management,and Prevention of Chronic Obstructive Lung Disease 2017 Report:GOLD Executive Summary[J].Am J Respir Crit Care Med,2017,195(5):557.
[10] Portillo K,Martinez-Rivera C,Ruiz-Manzano J.Anaemia in chronic obstructive pulmonary disease.Does it really matter?[J].Int J Clin Pract,2013,67(6):558.
[11] 梁世廉.慢性阻塞性肺疾病贫血的研究进展[J].临床肺科杂志,2015(12):2286.
[12] 王美平,姜利,朱波,等.机械通气患者贫血的临床观察研究[J].中华危重病急救医学,2012,24(2):70.
[13] Berkius J,Sundh J,Nilholm L,et al.What determines immediate use of invasive ventilation in patients with COPD?[J].Acta Anaesthesiol Scand,2013,57(3):312.
[14] 杨静,赵珂,王大庆.慢性阻塞性肺疾病急性加重期患者有创机械通气脱机困难相关危险因素分析[J].吉林医学,2018,39(1):42.
[15] Silverberg D S,Mor R,Weu M T,et al.Anemia and iron deficiency in COPD patients:prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron[J].BMC Pulm Med,2014,14(1):1.