【摘要】：[目的]探討死腔分數(shù)(VD/VT)對急性呼吸窘迫綜合征(ARDS)患者預(yù)后的評估價值。[方法]采用前瞻性臨床研究于2015年1月至2016年8月收集符合柏林標準的機械通氣ARDS患者32例。自入EICU起連續(xù)6天測定PaC02、ETCO2,利用FrankenfieldDC等研究提出的公式,即死腔分數(shù),VD/VT=0.320+0.0106(PaC02—ETCO2)+0.003(RR)+0.0015(Age)[1],計算 VD/VT,ARDS患者入EICU后行氣管插管后充分鎮(zhèn)靜鎮(zhèn)痛,調(diào)整PEEP至平穩(wěn)狀態(tài)后測定VD/VT,為第1天的死腔分數(shù),同時采集患者一般情況、生命體征、急性生理和慢性健康評分(APACHEⅡ)、肺損傷預(yù)測評分(LIPS)、氧合指數(shù)(Pa02/FiO2)、靜脈血二氧化碳分壓(PvCO2)、PEEP、平臺壓,選用Epidata3.02軟件包數(shù)據(jù)錄入,采用雙錄入方式對試驗數(shù)據(jù)進行錄入,兩次數(shù)據(jù)核對無誤后,采用spss 20.0統(tǒng)計學(xué)軟件包結(jié)合相關(guān)專業(yè)進行統(tǒng)計學(xué)分析。隨訪28天病死率;根據(jù)預(yù)后分存活組和死亡組,闡述死腔分數(shù)(VD/VT)在急性呼吸窘迫綜合征(ARDS)患者預(yù)后評估中的相關(guān)性、特異性及靈敏性。[結(jié)果]32例ARDS患者納入研究,死亡10例,存活22例,死亡率31.25%。ARDS患者發(fā)病6天內(nèi),VD/VT均升高,入院1-3天VD/VT兩組間差異無統(tǒng)計學(xué)意義,而4-6天死亡組均高于存活組(P0.001),第4天VD/VT死亡組較存活組明顯增高。存活組和死亡組VD/VT動態(tài)變化趨勢比較,死亡組1-6天VD/VT逐漸升高(P0.001),而存活組1-6天VD/VT變化趨勢差異無統(tǒng)計學(xué)意義。△VD/VT為28天獨立危險因素(P0.05),ROC曲線顯示:第4天預(yù)測ARDS預(yù)后的ROC曲線下面積(AUC)為0.961,以0.62為臨界值預(yù)測預(yù)后的敏感性和特異性分別為:0.900和0.955,顯著高于1天、5天、6天。與APACHEⅡ評分和LIPS評分比較,第4天V D/VT預(yù)測ARDS預(yù)后的ROC曲線下面積(AUC)為0.910,高于APACHEⅡ和LIPS評分,以0.62為臨界值預(yù)測預(yù)后的敏感性和特異性分別為:0.916和0.955。第4天VD/VT更能準確的判斷患者的預(yù)后。[結(jié)論]第4天死腔分數(shù)對ARDS患者預(yù)后評估有指導(dǎo)價值,與APACHE評分Ⅱ、LIPS評分相比,死腔分數(shù)對ARDS患者預(yù)后判斷更有臨床意義。
[Abstract]:[objective] to evaluate the prognostic value of dead chamber fraction (VD/VT) in patients with acute respiratory distress syndrome (ARDS). [methods] A prospective clinical study was conducted in 32 patients with mechanical ventilation (ARDS) who met Berlin standard from January 2015 to August 2016. PaC02ETCO2 was measured for 6 consecutive days from EICU. The formula proposed by FrankenfieldDC et al was used, that is, the dead chamber fraction was 0.0106 (PaC02-ETCO2) 0.003 (RR) 0.0015 (Age), and the patients with VD / VTARDS were given full sedation and analgesia after endotracheal intubation. After adjusting PEEP to a stable state, VD / V _ T was measured as the dead chamber fraction of the first day, and the general condition and vital signs of the patients were collected. Acute physiological and chronic health score (APACHE 鈪，

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