血管外肺水指数和肺血管通透性指数对脓毒性休克患者病情及预后的评估价值研究

摘要

目的：分析血管外肺水指数（EVLWI）和肺血管通透性指数（PVPI）对脓毒性休克患者病情及预后的评估价值。方法选取2011年3月—2015年12月佛山市禅城区中心医院和广东医学院附属医院重症医学科收治的脓毒性休克患者57例，根据入院28 d 预后情况分为生存组41例和死亡组16例。比较两组患者入住 ICU 第1、2、3天EVLWI 和 PVPI，分析 EVLWI 和 PVPI 与脓毒性休克患者急性生理学及慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、感染相关器官衰竭评分系统（SOFA）评分的相关性，并使用受试者工作特征（ROC）曲线评价 EVLWI 和 PVPI 对脓毒性休克患者预后的评估价值。结果入住 ICU 第1天两组患者 EVLWI 比较，差异无统计学意义（P ﹥0.05）；入住 ICU第2、3天死亡组患者 EVLWI 均高于生存组，入住 ICU 第1、2、3天死亡组患者 PVPI 均高于生存组（P ＜0.05）。生存组患者入住 ICU 第2、3天 EVLWI 和 PVPI 低于第1天，入住 ICU 第3天 EVLWI 和 PVPI 低于第2天（P ＜0.05）；死亡组患者入住 ICU 第1、2、3天 EVLWI 和 PVPI 比较，差异无统计学意义（ P ﹥0.05）。Spearman 秩相关性分析结果显示，EVLWI 与脓毒性休克患者 APACHEⅡ评分、SOFA 评分呈正相关（rs 值分别为0.531、0.625，P ＜0.05）；PVPI 与脓毒性休克患者 APACHEⅡ评分、SOFA 评分呈正相关（rs 值分别为0.658、0.610，P ＜0.05）。绘制入住 ICU 第1、2、3天 EVLWI 和 PVPI 评估脓毒性休克患者预后的 ROC 曲线，以入住 ICU 第3天 EVLWI ﹥11.65作为判断预后的最佳临界值，其灵敏度为74.3%、特异度为71.6%；以入住 ICU 第2天 PVPI ﹥4.95作为判断预后的最佳临界值，其灵敏度为72.5%、特异度为84.7%。结论 EVLWI 和 PVPI 能评估脓毒性休克患者的病情严重程度，且入住 ICU 第2天PVPI、入住 ICU 第3天 EVLWI 可作为评估脓毒性休克患者入院28 d 预后的指标。%Objective To analyze the assessment value of extravascular lung water index(EVLWI) and pulmonary vascular permeability index(PVPI)on illness severity and prognosis of patients with septic shock. Methods From March 2011 to December 2015,a total of 57 patients with septic shock were selected in the Intensive Care Unit(ICU),Central Hospital of Chancheng District,Foshan;in the ICU,the Affiliated Hospital of Guangdong Medical College. According to the prognosis after 28 days of admission,all of the 57 patients were divided into survivor group(n = 41)and death group(n = 16),EVLWI and PVPI were compared between the two groups after 1 day,2 days and 3 days of admission of ICU,and their correlations with APACHEⅡ score,with SOFA score were analyzed,ROC curve was drawn to evaluate the assessment value of EVLWI and PVPI on prognosis of patients with septic shock. Results No statistically significant differences of EVLWI was found between the two groups after 1 day of admission of ICU( P ﹥ 0. 05);EVLWI of death group was statistically significantly higher than that of survivor group after 2 days and 3 days of admission of ICU,respectively( P < 0. 05);PVPI of death group was statistically significantly higher than that of survivor group after 1 day,2 days and 3 days of admission of ICU,respectively(P < 0. 05). Of survivor group,EVLWI and PVPI after 2 days and 3 days of admission of ICU were statistically significantly lower than those after 1 day of admission of ICU,EVLWI and PVPI after 3 day of admission of ICU were statistically significantly lower than those after 2 days of admission of ICU(P < 0. 05);of death group,there was no statistically significant differences of EVLWI or PVPI after 1 day,2 days or 3 days of admission of ICU( P ﹥ 0. 05). Spearman rank correlation analysis showed that,EVLWI was positively correlated with APACHEⅡ score,SOFA score of patients with septic shock,respectively(rs = 0. 531,0. 625,P <0. 05);PVPI was positively correlated with APACHEⅡ score,SOFA score of patients with septic shock,respectively( rs =0. 658,0. 610,P < 0. 05). ROC curve showed that,after 3 days of admission of ICU,EVLWI ﹥ 11. 65 was the best critical value in predicting the prognosis of patients with septic shock,the sensitivity was 74. 3% ,the specificity was 71. 6% ;after 2 days of admission of ICU,PVPI ﹥ 4. 95 was the best critical value in predicting the prognosis of patients with septic shock,the sensitivity was 72. 5% ,the specificity was 84. 7% . Conclusion EVLWI and PVPI can evaluate the illness severity of patients with septic shock,PVPI after 2 days of admission of ICU,EVLWI after 3 days of admission of ICU can be used in predicting the prognosis after 28 days of admission.