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目的探讨血清降钙素原(PCT)联合血管外肺水指数(EVLWI)在脓毒症合并急性呼吸窘迫综合征(ARDS)患者预后评估中价值。方法选择55例脓毒症合并ARDS患者,其中住院期间存活28例(存活组)、死亡27例(死亡组)。比较两组患者WBC、C反应蛋白、氧合指数、平均动脉压、中心静脉压、心脏指数、全身血管阻力指数、全心舒张末期容积指数、PCT、EVLWI等指标的差异,采用多因素logistic回归分析探讨影响脓毒症合并ARDS患者预后的相关因素,受试者工作特征曲线(ROC)评价PCT、EVLWI对脓毒症合并ARDS患者死亡的预测效能。结果死亡组PCT、EVLWI高于存活组(P<0.05)。PCT、EVLWI是影响脓毒症合并ARDS患者预后的独立危险因素(P<0.05)。PCT、EVLWI、PCT联合EVLWI判断患者预后的ROC曲线下面积(AUC)分别为0.944、0.908、0.952。结论 PCT和EVLWI均可作为脓毒症合并ARDS患者预后评估有效的指标,二者联合可明显提高对脓毒症合并ARDS患者死亡危险性预测的准确度。
Objective To investigate the value of serum procalcitonin (PCT) combined with extravascular lung water index (EVLWI) in the prognosis evaluation of patients with sepsis and acute respiratory distress syndrome (ARDS). Methods Fifty-five patients with sepsis and ARDS were enrolled. Among them, 28 survived (survival) and 27 died (death) during hospital stay. The differences of WBC, C-reactive protein, oxygenation index, mean arterial pressure, central venous pressure, cardiac index, systemic vascular resistance index, endocardial end-diastolic volume index, PCT and EVLWI were compared between the two groups. Multivariate logistic regression To analyze the influencing factors of the prognosis of patients with sepsis complicated with ARDS and the receiver operating characteristic curve (ROC) to evaluate the predictive efficacy of PCT and EVLWI on the mortality of patients with sepsis and ARDS. Results The PCT and EVLWI in death group were higher than those in survival group (P <0.05). PCT and EVLWI were independent risk factors affecting the prognosis of patients with sepsis and ARDS (P <0.05). The area under the ROC curve (AUC) of PCT, EVLWI and PCT combined with EVLWI in predicting the prognosis of patients was 0.944,0.908 and 0.952, respectively. Conclusion Both PCT and EVLWI can be used as predictors of prognosis in patients with sepsis and ARDS. The combination of the two can significantly improve the accuracy of predicting the risk of death in patients with sepsis and ARDS.