摘要
目的探讨急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和血浆血管性血友病因子(vWF)在诊断急性呼吸窘迫综合征(ARDS)肺损伤程度及评估预后中的临床价值。方法选择我院2014年3月—2017年2月收治的ARDS 90例,根据预后分为存活组(n=60)与死亡组(30例)。比较两组在确诊为ARDS后第1天、第3天APACHEⅡ评分、vWF水平、肺损伤评分及氧合指数变化,分析APACHEⅡ评分、vWF与预后的相关性。结果与死亡组比较,存活组在确诊为ARDS后第1天及第3天vWF水平、APACHEⅡ评分及肺损伤评分均降低,氧合指数升高,差异有统计学意义(P<0.05);与确诊为ARSD后第1天比较,第3天两组vWF水平、APACHEⅡ评分均升高,但存活组第3天肺损伤评分降低,氧合指数升高,而死亡组肺损伤评分升高,氧合指数降低,差异有统计学意义(P<0.05)。在确诊为ARDS后第1天、第3天APACHEⅡ评分、vWF水平均与肺损伤评分呈正相关;确诊为ARDS后第1天vWF、APACHEⅡ评分的受试者工作特征(ROC)曲线下面积分别为0.91、0.87,第3天ROC曲线下面积分别为0.68、0.61。结论 APACHEⅡ评分及vWF水平对ARDS早期肺损伤程度及预后评估具有较高的应用价值。
Objective To investigate acute physiology and chronic health evaluation systemⅡ（ APACHEⅡ） score and plasma von willebrand factor （ vWF） in diagnosis of degree of lung injury and value in evaluation of prognosis of patients with acute respiratory distress syndrome （ ARDS） . Methods A total of 90 ARDS patients admitted during March 2014 and February 2017 were divided into survival group （n=60） and death group （n=30） according to the prognosis. In two groups, APACHE Ⅱ scores, vWF levels, changes in lung injury score and oxygenation index on the 1st d and 3rd d after confirming the diagnosis of ARDS were analyzed, and relations between APACHEⅡscore and vWF with prognosis were analyzed. Results Compared with those in death group, in survival group, vWF levels, APACHE Ⅱ scores and lung injury scores on the 1st d and 3rd d after confirming the diagnosis of ARDS were significantly lower, while values of oxygenation indexes were significant-ly higher （P〈0. 05）. Compared with those on the 1st d and 3rd d after confirming the diagnosis of ARDS, vWF levels and APACHEⅡ scores were significantly higher, while lung injury score was significantly lower in survival group, and the scorewas significantly higher in death group （P〈0. 05）. On the 1st d and 3rd d after confirming the diagnosis of ARDS, APACHEⅡ scores and vWF levels were positively correlated with lung injury score. Areas under the receiver-operating characteristic （ROC） curve of vWF and APACHE Ⅱscore on the 1st d after confirming the diagnosis of ARDS were 0. 91 and 0. 87, while areas under the ROC curve on the 3rd d after confirming the diagnosis of ARDS were 0. 68 and 0. 61 respectively. Conclusion APACHE Ⅱ score and vWF level have application value in diagnosis of degree of lung injury and value in evaluation of prognosis of patients with ARDS.
作者
夏蕾
XIA Lei(Emergency Department,85 Hospital of PLA,Shanghai 200050,Chin)
出处
《临床误诊误治》
2017年第12期79-82,共4页
Clinical Misdiagnosis & Mistherapy
基金
上海市卫生局科研课题计划项目(20110271)
关键词
呼吸窘迫综合征
成人
肺损伤
预后
Respiratory distress syndrome
adult
Lung injury
Prognosis
