强离子隙在急性呼吸衰竭中的应用研究

发布时间：2018-12-11 09:03

【摘要】：目的1.筛选可发现急性呼吸衰竭患者体内复杂酸碱紊乱且能评估预后的指标,并进行比较。2.评估强离子隙作为急性呼吸衰竭患者死亡风险预测因子的临床价值。方法1.收集本院符合急性呼吸衰竭诊断标准患者106例,其中男性60例,女性46例,年龄13~88岁,平均54±17岁。同时配对选取同期入院、病区相同、性别相同、年龄相近(年龄16~92岁,平均55±18岁)的106例病例作为对照组。经分析,实验组与对照组在年龄、性别等方面无统计学差异(p0.05),具有可比性;2.检测酸碱紊乱各指标:K+、CL-、HCO3-、AG、p H、ALB、SIG、Cr、lactic acid、Pa CO2、Pa O2、Na+、PO4-。3.采用t检验进行组间比较,筛选差异指标。4.采用SPSS 17.0统计软件绘制ROC曲线,比较差异指标。5.分析ROC曲线相关参数,评估指标的临床价值。结果1.ARF发生率最高的基础疾病是急性呼吸窘迫综合征(占26%)和心源性肺水肿(占26%)。而在已发生ARF的所有基础疾病中,病程最凶险的是急性肺梗死,一旦出现ARF,死亡率高达50%。2.ARF组T1与对照组相比,K+、CL-、HCO3-、AG、p H、ALB、SIG、Cr、lactic acid、Pa CO2、Pa O2水平均有统计学差异(P0.01);Na+和PO4-无差别。但恢复组T2与对照组相比,各指标均无统计学上的差异。3.发生ARF的患者中,恢复组T1与死亡组T1,检测结果各指标比较:两组间只有AG、SIG差异有统计学意义(P0.01)。4.AG和SIG这两个预测指标相关ROC曲线参数相比较:SIG的曲线下面积更大,达到0.904,诊断准确性高;以15.4 mmol/L作为AG的cut-off值,以6.77 mmol/L作为SIG的cut-off值,计算相关ROC曲线参数,SIG的敏感度、Youden指数、阴性预测值、阴性似然比等参数也优于AG。结论1.在发生急性呼吸衰竭之初,AG和SIG就可以较敏感地体现患者的复合酸碱紊乱状态,且AG和SIG指标有可能作为预测ARF患者死亡风险的预测因子,提示预后不良。2.作为急性呼吸衰竭患者死亡风险的预测因子,SIG优于AG。3.当cut-off值设为6.77 mmol/L时,SIG的检测结果低于cut-off值,SIG的阴性似然比为0,敏感度高达1.000,如果诊断结果为阴性,能立刻排除患者死亡风险。
[Abstract]:Objective 1. Screening can find complex acid-base disorder in patients with acute respiratory failure and can evaluate prognosis. 2. 2. To evaluate the clinical value of strong ion gap as a predictor of death risk in patients with acute respiratory failure. Method 1. 106 patients with acute respiratory failure (ARF) were collected, including 60 males and 46 females, aged 1388 years with an average age of 54 卤17 years. At the same time, 106 cases who were admitted to hospital in the same period, the same area, the same sex, and the same age (age 16 ~ 92 years, mean 55 卤18 years) were selected as the control group. By analysis, the experimental group and control group in age, sex and other aspects of no statistical difference (p0.05), comparable; 2. Detection of various indexes of acid-base disorder: K, CL-,HCO3-,AG,p HALBX SIGLYL acid,Pa CO2,Pa O2O2O2O2NNA, PO4-.3. T test was used to compare and screen the difference index. 4. 4. SPSS 17.0 statistical software was used to draw the ROC curve, and the difference index was compared. 5. 5. To analyze the relevant parameters of ROC curve and evaluate the clinical value of the indexes. Results the highest incidence of 1.ARF was acute respiratory distress syndrome (26%) and cardiogenic pulmonary edema (26%). Of all the underlying diseases that have occurred with ARF, the most dangerous course of disease is acute pulmonary infarction. Once ARF, mortality is as high as T1 in the 50%.2.ARF group, it is higher than that in the control group, compared with the control group. The levels of Pa CO2,Pa O 2 were significantly different (P0.01). There was no difference between Na and PO4-. However, there was no statistical difference in T 2 between the recovery group and the control group. Among the patients with ARF, T1 of recovery group and T1 of death group were compared with each other: there was only AG, between the two groups. The difference of SIG was statistically significant (P0.01). The relative ROC curve parameters of 4.AG and SIG were compared: the area under the curve of SIG was larger, reaching 0.904, and the diagnostic accuracy was high; Using 15.4 mmol/L as cut-off value of AG and 6.77 mmol/L as cut-off value of SIG, the parameters of relevant ROC curve, SIG sensitivity, Youden index, negative predictive value and negative likelihood ratio are also better than AG.. Conclusion 1. In the early stage of acute respiratory failure, AG and SIG can sensitively reflect the complex acid-base disorder of patients, and AG and SIG indexes may be used as predictors of death risk in ARF patients, suggesting that the prognosis is not good. 2. As a predictor of death risk in patients with acute respiratory failure, SIG is superior to AG.3. When the cut-off value was 6.77 mmol/L, the detection result of SIG was lower than that of cut-off, the negative likelihood ratio of SIG was 0, the sensitivity was as high as 1.000.If the diagnosis result was negative, the risk of death could be eliminated immediately.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R563.8

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