摘要
目的：探讨急性呼吸窘迫综合征（ ARDS）患者呼吸模式调整的预警因素。方法回顾性分析49例ARDS患者入科24 h内接受不同呼吸模式的临床资料，收集入科时的22项定量指标及5项分类变量。呼吸模式以能维持24 h为准，分为有创通气组及无创通气组。结果7 d及28 d死亡率在有创通气组分别为46．1％（12／26）及65．3％（17／26），高于无创通气组的0（0／23）及13．0％（3／23）。两组基本资料中是否需要血管活性药物、肺内外因素、心率、GCS评分、APACHEⅡ评分、肌酐、乳酸及血小板计数比较差异均有统计学意义（ P ＜0．05）。二项式Logistic回归分析证实，以上8项指标对调整为有创通气具有预测价值，但并非独立预警因素。采用受试者工作特征（ ROC）曲线，计算出其中6项定量指标的参考阈值为APACHEⅡ评分＞17分、GCS评分≤13分、心率＞123次／min、乳酸＞3．6 mmol／L、血小板≤191×10^9／L和肌酐＞66 mmol／L。结论8项预警因素提示机体存在失去代偿风险，无创通气往往无法满足需要，需尽早调整为有创通气支持。
Objective To evaluate the predicting factors on the change of ventilation mode for patients with adult respiratory distress syndrome （ ARDS） .Methods To respective analysis the clinical data of 49 patients with ARDS who need change ventilation mode within 24 hours after admission. Twenty-two quantitative indicators and five classification variables was collected for analysis.A classification of patients into invasive or noninvasive groups was based on ventilation mode after 48 hours.Results The death rate at day 7 and day 28 revealed statistical difference among these two subgroups （12 vs 0, 17 vs 3, P〈0.05）.Statistical differences （P〈0.05） were also found at clinical data including whether need vasoactive agent, pulmonary and extra-pulmonary inducement, heart rate, GCS score, APACHEⅡscore, creatinine, lactic acid and platelets.Binomial logistic regression analysis revealed predicting function on change of ventilation mode at the above data but none of them was independent predictors.Receiver -operating characteristic curve calculated the cut off value of 6 quantitative indicators containing APACHEⅡscore〉17, GCS score〈13, heart rate〉123/min, lactic acid 〉3.6 mmol/L platelets 〈191×10^9/L and creatinine 〉66 mmol/L.Conclusion Our investigation confirms 8 predicting factors indicating the lose control of compensatory ability for ARDS patients.In this situation, noninvasive ventilation mode can not match the need of therapy, so change of invasive ventilation mode should been performed as soon as possible.
出处
《中国急救医学》
CAS
CSCD
北大核心
2015年第8期697-701,共5页
Chinese Journal of Critical Care Medicine
基金
：深圳市科技研发资金基础研究项目（深科发[2014]417）
深圳市宝安区科技计划项目（深宝科[2014]33-07）
