欧美联席会议和柏林标准对于急性呼吸窘迫综合征预测的比较

摘要

Objective To compare the effectiveness of American -European Consensus Conference ( AECC) and Berlin criteria in predicting the mortality of acute respiratory distress syndrome patients.Methods The data of patients who admitted to intensive care unit ( ICU) of Cancer Hospital Chinese Academy of Medical Sciences were retrospectively reviewed and analyzed.Results There were 25 acute lung injury and 68 acute respiratory distress syndrome ( ARDS) patients according to AECC criteria.Compared with acute lung injury patients, patients who diagnosed as ARDS had more severe disease (APACHEⅡ score 14.50 ±7.87 vs 14.42 ±4.40, P =0.004), higher positive end -expiratory pressure level [(5.14 ±0.38)cm H2O vs (6.20 ±2.17)cm H2O, P=0.048], higher ICU mortality (4.0%vs 31.2%, P=0.014) and hospital mortality (8.0%vs 31.2%, P=0.042).There were 25 mild ARDS,64 moderate and 4 severe ARDS patients.Compared with mild ARDS, patients who were diagnosed as moderate or severe ARDS had more severe disease ( APACHEⅡ score14.50 ± 7.87 vs 15.47 ±6.21 vs 16.50 ±3.70; P=0.016), higher positive end-expiratory pressure level [(5 .14 ±0.38)cm H2O vs (5.71 ±1.49)cm H2O vs (9.00 ±3.61) cm H2O, P=0.048], higher ICU mortality (4.0%vs 31.2%vs 50.0%, P=0.014) and hospital mortality (8.0% vs 31.2% vs 50.0%, P=0.042).Receiver operating curve analysis showed that area under the receiver operating curve was 0.650 ±0 .059 (95%CI 0.533~0.766, P=0.032) for AECC criteria and 0.665 ±0.060 (95%CI 0.548~0.781, P=0.018) for Berlin criteria in predicting ICU mortality.Conclusion Both AECC and Berlin criteria can stratify acute lung injury or ARDS patients by ventilator index and clinical outcomes.Berlin criteria may well guide clinical practice and scientific research due to its more accurate staging of ARDS.%目的：比较欧美联席会议（ American－European Consensus Conference， AECC）和柏林标准对于急性呼吸窘迫综合征（ acute respiratory distress syndrome， ARDS）病死率预测的有效性。方法回顾性分析中国医学科学院肿瘤医院重症医学科（ intensive care unit， ICU）2007－01～2009－10收治的全部 ARDS患者资料。结果根据 AECC 标准，全组25例急性肺损伤（ ALI），68例ARDS。与ALI患者比较，ARDS患者的病情重（转入时 APACHEⅡ评分14．50±7．87比14．42±4．40，P＝0．004）、需要更高的PEEP水平[（5．14±0．38）cm H2O比（6．20±2．17）cm H2O，P＝0．048）、ICU 病死率（4．0％比31．2％，P ＝0．014）和住院病死率更高（8．0％比31．2％，P＝0．042）。根据柏林标准，全组25例轻度ARDS，64例中度ARDS，4例重度ARDS。随着分期的增加，患者的病情逐渐加重（转入时APACHEⅡ评分14．50±7．87比15．47±6．21比16．50±3．70， P＝0．016）、需要更高的PEEP水平[（5．14±0．38）cm H2O比（5．71±1．49）cm H2O比（9．00±3．61）cm H2O，P＝0．048]、ICU病死率（4．0％比31．2％比50．0％，P＝0．014）和住院病死率更高（8．0％比31．2％比50．0％，P ＝0．042）。受试者工作特征曲线分析发现，AECC和柏林标准预测ICU病死率的受试者工作曲线下面积分别为0．650±0．059（95％CI 0．533～0．766，P＝0．032）和0．665±0．060（95％CI 0．548～0．781，P＝0．018）。结论 AECC分期和柏林分期均能从临床呼吸机指标方面和近期预后方面很好地对ALI／ARDS患者进行分层。由于柏林分期将ARDS分为轻度、中度和重度，因此该项标准可能更好地指导临床实践和科学研究。