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目的:探讨血管外肺水指数(EVLWI)和肺毛细血管通透性指数(PVPI)与急性呼吸窘迫综合征(ARDS)严重程度分级的关系,评价二者对ARDS严重程度及预后的临床意义。方法:回顾性分析33名ARDS患者的临床资料,根据ARDS柏林定义,按氧合指数(OI)分为轻、中、重度3组,其中轻度组(n=8),中度组(n=14),重度组(n=11),动态观测患者入ICU第1、3、5天OI、EVLWI、PVPI的变化,并进行急性生理和慢性健康评价(APACHE II)评分及感染相关性器官衰竭评价(SOFA)评分,比较不同程度ARDS患者的EVLWI与PVPI值。分析EVLWI与PVPI、APACHE II评分、SOFA评分、OI的相关性,使用受试者工作特征曲线(ROC曲线)评价EVLWI、PVPI、OI对ARDS预后的价值。结果:重度组EVLWI、PVPI、APACHE II、SOFA评分和28 d病死率均高于轻度组(P<0.01),ARDS患者EVLWI与PVPI、APACHEII评分、SOFA评分正相关(r=0.892,0.375,0.422,P<0.01),EVLWI与OI呈负相关(r=-0.429,P<0.01)。入ICU第1、3、5天EVLWI、PVPI对ARDS患者预后评价的ROC曲线下面积(AUC)分别为0.565、0.667、0.869;0.512、0.768、0.750,以入ICU第5天EVLWI>9.5 m L/kg作为判断预后的最佳临界值,敏感度为75%,特异度为71.4%;以入ICU第3天PVPI>2.15作为判断预后的最佳临界值,其敏感度为75%,特异度为85.7%。结论:动态观测EVLWI和PVPI,对于评估ARDS患者病情的严重程度及预后具有重要意义。
Objective: To investigate the relationship between the extravascular lung water index (EVLWI) and pulmonary capillary permeability index (PVPI) and the severity of acute respiratory distress syndrome (ARDS), and evaluate the clinical significance of the two in evaluating the severity and prognosis of ARDS. Methods: The clinical data of 33 patients with ARDS were retrospectively analyzed. According to the ARDS Berlin definition, the data were divided into mild, moderate and severe groups according to the oxygenation index (OI), in which mild group (n = 8), moderate group = 14) and severe group (n = 11). The changes of OI, EVLWI and PVPI on the 1st, 3rd and 5th day in the ICU were observed dynamically. The acute physiology and chronic health assessment (APACHE II) score and infection-related organ failure Evaluation (SOFA) score to compare the EVLWI and PVPI values of ARDS patients with different degrees. The correlation between EVLWI and PVPI, APACHE II score, SOFA score and OI was analyzed. The value of EVLWI, PVPI and OI on the prognosis of ARDS was evaluated using receiver operating characteristic curve (ROC curve). Results: The EVLWI, PVPI, APACHE II, SOFA score and 28-day mortality in severe group were significantly higher than those in mild group (P <0.01). EVLWI was positively correlated with PVPI, APACHEII score and SOFA score in ARDS patients (r = 0.892,0.375, 0.422, P <0.01). There was a negative correlation between EVLWI and OI (r = -0.429, P <0.01). The area under the ROC curve (AUC) of EVLWI and PVPI in evaluating the prognosis of patients with ARDS on the 1st, 3rd, 5th day of ICU were 0.565, 0.667, 0.869, 0.512, 0.768 and 0.750 respectively, / kg as the best threshold for prognosis, the sensitivity was 75%, specificity was 71.4%; into the ICU day PVPI> 2.15 as the best prognosis of the critical value, the sensitivity was 75%, specificity 85.7%. Conclusion: The dynamic observation of EVLWI and PVPI is of great significance for assessing the severity and prognosis of ARDS patients.