【摘要】：目的探討氧合指數(shù)(PaO_2/Fi O_2)預(yù)測(cè)急性左心衰竭(ALHF)患者機(jī)械通氣及預(yù)后的價(jià)值。方法選擇2011年1月—2015年5月黔東南州人民醫(yī)院ICU收治的ALHF患者48例,入院立即監(jiān)測(cè)患者氧分壓(PaO_2)、二氧化碳分壓(PaCO_2)、氧飽和度(SaO_2)、標(biāo)準(zhǔn)堿剩余(SBE)、動(dòng)脈血乳酸(Lac),入院6 h再次檢測(cè)Lac,計(jì)算入院時(shí)PaO_2/Fi O_2及6 h乳酸清除率。并予急性生理學(xué)與慢性健康狀況評(píng)分系統(tǒng)Ⅱ(APACHEⅡ)評(píng)分。分析PaO_2/Fi O_2與性別、年齡、是否機(jī)械通氣、是否死亡、PaO_2、PaCO_2、Sa O_2、SBE、Lac、6 h乳酸清除率、APACHEⅡ評(píng)分的關(guān)系,通過繪制受試者工作特征曲線(ROC曲線),分析PaO_2/Fi O_2判斷機(jī)械通氣及死亡的靈敏度和特異度,并找出臨界值進(jìn)一步對(duì)ALHF進(jìn)行危險(xiǎn)分層。結(jié)果 ALHF患者PaO_2/Fi O_2為(196.7±51.2),15例患者行機(jī)械通氣,6例患者死亡。PaO_2/Fi O_2與機(jī)械通氣、死亡、Lac、APACHEⅡ評(píng)分呈負(fù)相關(guān),與PaO_2、Sa O_2呈正相關(guān)關(guān)系(P0.05);PaO_2/Fi O_2與性別、年齡、住院時(shí)間、PaCO_2、SBE、6 h乳酸清除率無明顯相關(guān)關(guān)系(P0.05)。ROC曲線顯示,PaO_2/Fi O_2為176.6時(shí),預(yù)測(cè)機(jī)械通氣的靈敏度為81.8%,特異度為80.0%,AUC=0.782,OR值為0.066;PaO_2/Fi O_2為150.8時(shí),預(yù)測(cè)死亡的靈敏度為85.7%,特異度為60.0%,AUC=0.798,OR值為0.135。機(jī)械通氣/死亡PaO_2/Fi O_2臨界值者的APACHEⅡ評(píng)分均高于機(jī)械通氣/死亡PaO_2/Fi O_2臨界值者的APACHEⅡ評(píng)分,差異有統(tǒng)計(jì)學(xué)意義(Z=-5.268,P0.001;Z=-6.077,P0.001)。結(jié)論 PaO_2/Fi O_2水平可以判斷ALHF患者病情的嚴(yán)重程度,并可預(yù)測(cè)是否需要機(jī)械通氣及預(yù)后。
[Abstract]:Objective to evaluate the prognostic value of PaO_2/Fi O _ 2 in predicting mechanical ventilation and prognosis in patients with acute left ventricular failure (ALHF). Methods from January 2011 to May 2015, 48 patients with ALHF were selected from ICU of Qiandongnan people's Hospital. Oxygen partial pressure (PaO_2), partial pressure of carbon dioxide (PaCO_2), oxygen saturation (SaO_2), standard base residual (SBE), arterial lactate (Lac), were monitored immediately after admission. The acute physiology and chronic health status scoring system 鈪，

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