老年呼吸衰竭合并脓毒性休克患者血管外肺水指数的测定与预后

摘要

目的：探讨老年呼吸衰竭合并脓毒性休克患者血管外肺水指数（ EVLWI ）的特点及其对死亡的预测价值。方法36例老年呼吸衰竭合并脓毒性休克患者，按其临床结局分为存活组21例和死亡组15例，采用PICCO plus检测仪监测两组患者 EVLWI、全心射血分数（ GEF ）、系统血管阻力（ SVRI ）、中心静脉压（ CVP）、心指数（ CI ）、心率（ HR ）、平均动脉压（ MAP ）并监测 APACHEⅡ评分及血乳酸。结果死亡组APACHEⅡ评分、血乳酸水平、EVLWI高于存活组（P均＜0．05），两组CI、GEF、SVRI、CVP、HR及MAP比较，差异均无统计学意义（P均＞0．05）。描绘EVLWI的ROC曲线发现以EVLWI≥10 ml/kg为界点，预测死亡发生的灵敏度为66．67％，特异度为90．48％，阳性预测值83．33％，阴性预测值79．17％。结论老年呼吸衰竭合并脓毒性休克患者EVLWI明显增高者死亡率高，以EVLWI≥10 ml/kg为界点可作为判断预后不良的指标。%Objective To investigate the characteristics and prognostic value of extravascular lung water index ( EVLWI ) for the death in elderly patients with respiratory failure and septic shock .Methods Thirty-six elderly patients with respiratory failure and septic shock were divided into survival group ( 21 patients ) and death group ( 15 patients) according to clinical outcome .All the patients were monitored with pulse indicator continuous cardiac output (PICCO) monitor,and their EVLWI,general ejection fraction (GEF),system vascular resistance index (SVRI),central venous pressure ( CVP ) , cardiac index ( CI ) , heart rate ( HR ) and mean arterial pressure ( MAP ) were collected;The APACHEⅡscore and blood lactate(Lac) and were also recorded .Results APACHEⅡscore,Lac,EVLWI in the death group were significantly higher than those in the survival group (P<0.05),CI,GEF,SVRI,CVP,HR and MAP showed no significant difference between two groups ( all P>0 .05 ) .The ROC curve of EVLWI indicated that EVLWI≥10 ml/kg could be the value of prognosis for death ,and the sensitivity,specificity,positive predictive value,negative predictive value were 66.67%,90.48%,83.33%,79.17% respectively.Conclusion The mortality of elderly patients with respiratory failure and septic shock increases while EVLWI is significantly higher ,EVLWI≥10 ml/kg can be the value of prognosis for death .