肺泡死腔分数与急性呼吸窘迫综合征患儿病情及预后关系的研究

摘要

目的 探讨肺泡死腔分数( alveolar dead space fraction,ADSF)与急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患儿病情及预后的关系.方法 纳入2016年12月至2017年11月间中国医科大学附属盛京医院PICU收治的早期ARDS患儿20例,根据OI值及发病28 d存活与否分为轻中度组(4≤OI<16),重度组(OI≥16);存活组与死亡组.记录患儿一般情况、动脉血二氧化碳分压(PaCO2)、呼气末二氧化碳分压(PetCO2)、氧合指数( P/F、OI)以及发病28 d病死率.经由公式ADSF＝(PaCO2-PetCO2)/PaCO2测定ADSF.运用相应统计学方法 分析ADSF与ARDS患儿病情严重程度的关系及其对预后的预测价值.结果 (1)20例患儿中,轻中度组12例,重度组8例,与轻中度组相比,重度组 OI、ADSF显著升高,P/F显著降低( P<0. 05). (2) 20 例患儿中存活11 例,死亡9例,与存活组相比,死亡组OI、ADSF显著升高,P/F显著降低(P<0. 05). ADSF判定预后的ROC曲线下面积(AUC)为0. 690(P<0. 05),当以0. 338为判定预后的临界值时,其判定死亡的敏感度和特异度分别为0. 704和0. 634;OI判定预后的AUC为0. 720(P<0. 05),当以0. 348为预测死亡的临界值时,其敏感度与特异度分别为0. 551 和0. 797;P/F 判定预后的 AUC 为0. 256(P >0. 05).结论 重度ARDS患儿发病早期ADSF高于轻中度ARDS患儿;ARDS死亡患儿发病早期ADSF高于存活患儿.ADSF对ARDS的预后判断具有指导价值.%Objective To investigate the role of alveolar dead space fraction(ADSF) on the severity and outcome among children with acute respiratory distress syndrome ( ARDS). Methods Totally 20 chil-dren with ARDS in early stage were enrolled in this prospective study from December 2016 to November 2017 in PICU of Shengjing Hospital of China Medical University. According to the OI value,the cases were devided into mild-moderate group(4≤OI <16,n ＝12)and severe group (OI≥16,n ＝8). According to 28-day hospital mortality,the cases were devided into survival group(n＝11) and death group (n＝9). The general situation,PaCO2,PetCO2,oxygenation index(P/F,O/I) and 28-day hospital mortality were recorded and evaluated,and ADSF was measured by ADSF＝( PaCO2-PetCO2)/PaCO2. These variables were ana-lyzed by using student′s t-test,non-parametric test and ROC curve,to analyze the relationship between the severity of ARDS and ADSF,and the predictive value of the prognosis. Results (1) Compared with the mild-moderate group,the OI and ADSF of the severe group were significantly higher,and the P/F was signif-icantly lower(P<0. 05). (2)Compared with the survival group,the OI and ADSF of the death group were significantly higher,and the P/F was significantly lower(P<0. 05). (3)The area under the ROC judged by ADSF was 0. 690 (P<0. 05). If 0. 338 was as the critical value to evaluate the prognosis,the sensitivity and specificity for judging death were 0. 704 and 0. 634,respectively. The AUC of predicting the prognosis with OI was 0. 720 (P<0. 05). If 0. 348 was as the critical value to predict death,the sensitivity and specificity were 0.551 and 0.797,respectively. The area under the ROC judged by P/F was 0.256(P > 0.05). Conclusion The ADSF on early stage is higher in children with severe ARDS than those with mild to moderate ARDS. The ADSF on early stage is higher in death group than that in survival group. ADSF is of guiding significance in the prognosis of ARDS.