氧合指数在急性左心衰竭中的应用价值

发布时间：2018-10-17 11:06

【摘要】：目的探讨氧合指数(PaO_2/Fi O_2)预测急性左心衰竭(ALHF)患者机械通气及预后的价值。方法选择2011年1月—2015年5月黔东南州人民医院ICU收治的ALHF患者48例,入院立即监测患者氧分压(PaO_2)、二氧化碳分压(PaCO_2)、氧饱和度(SaO_2)、标准碱剩余(SBE)、动脉血乳酸(Lac),入院6 h再次检测Lac,计算入院时PaO_2/Fi O_2及6 h乳酸清除率。并予急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。分析PaO_2/Fi O_2与性别、年龄、是否机械通气、是否死亡、PaO_2、PaCO_2、Sa O_2、SBE、Lac、6 h乳酸清除率、APACHEⅡ评分的关系,通过绘制受试者工作特征曲线(ROC曲线),分析PaO_2/Fi O_2判断机械通气及死亡的灵敏度和特异度,并找出临界值进一步对ALHF进行危险分层。结果 ALHF患者PaO_2/Fi O_2为(196.7±51.2),15例患者行机械通气,6例患者死亡。PaO_2/Fi O_2与机械通气、死亡、Lac、APACHEⅡ评分呈负相关,与PaO_2、Sa O_2呈正相关关系(P0.05);PaO_2/Fi O_2与性别、年龄、住院时间、PaCO_2、SBE、6 h乳酸清除率无明显相关关系(P0.05)。ROC曲线显示,PaO_2/Fi O_2为176.6时,预测机械通气的灵敏度为81.8%,特异度为80.0%,AUC=0.782,OR值为0.066;PaO_2/Fi O_2为150.8时,预测死亡的灵敏度为85.7%,特异度为60.0%,AUC=0.798,OR值为0.135。机械通气/死亡PaO_2/Fi O_2临界值者的APACHEⅡ评分均高于机械通气/死亡PaO_2/Fi O_2临界值者的APACHEⅡ评分,差异有统计学意义(Z=-5.268,P0.001;Z=-6.077,P0.001)。结论 PaO_2/Fi O_2水平可以判断ALHF患者病情的严重程度,并可预测是否需要机械通气及预后。
[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，

本文编号：2276455