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机械通气的休克患者肺部非重力依赖区超声评分与不良预后的相关性研究

Correlation Between the Severity of Lung Ultrasound Score in Non-gravity Dependent Areas and Poor Prognosis of Patients with Shock and on Mechanical Ventilation

    摘要
  • 摘要:
      目的  探索肺部非重力依赖区(1~2区)超声异常是否和机械通气休克患者不良预后相关。
      方法  回顾性分析2016年4月至2017年11月181例休克患者肺部超声检查数据，按照28 d存活情况分为生存组与死亡组，通过单因素和多因素Cox回归分析肺部整体和各分区评分对28 d死亡的影响，Kaplan-Meier曲线分析肺部1~2区超声病变程度与28 d预后生存的关系。
      结果  最终纳入169例患者。其中男性106例(62.7%)，女性63例(37.3%)。生存组90例，死亡组79例。单因素Cox回归分析发现，调整年龄、急性生理与慢性健康(APACHE)Ⅱ评分、乳酸水平、每小时尿量、使用血管活性药物情况、氧合指数前后，肺部整体(1~6区)、1~2区、3~4区超声评分均与28 d死亡相关。进一步行多因素Cox回归分析发现，仅肺部1~2区超声评分、APACHE Ⅱ、乳酸水平是28 d死亡的独立危险因素。Kaplan-Meier曲线发现，1~2区病变程度越重，28 d生存率越低。
      结论  机械通气休克患者肺部1~2区超声评分或可作为28 d不良预后的预测指标。

     

    Abstract:
      Objective  To explore whether ultrasound abnormalities in the non-gravity dependent areas (area 1-2) of the lungs are associated with poor prognosis in patients with shock and on mechanical ventilation.
      Methods  We retrospectively analyzed the data of lung ultrasound from 181 patients with shock from Apr. 2016 to Nov. 2017. The patients were divided into the survival group and the non-survival group according to the 28 d outcome. Single factor and multivariate Cox regression were used to analyze the relationship between lung ultrasound score of the overall and each area and the 28 d mortality.Kaplan-Meier curve was used to analyze the relationship between the severity of ultrasound lesions in area 1-2 and the prognosis at 28 d.
      Results  169 patients were included.There were 106 males (62.7%) and 63 females (37.3%).There were 90 patients in the survivel group and 79 patients in the non-survival group.Single factor Cox regression analysis found that adjusting the age, acute physiology and chronic health evaluation (APACHE) Ⅱ score, lactate level, urine output per hour, application of vasoactive agent, oxygenation index, lungs ultrasound score of area 1-6, area 1-2 and area 3-4 were associated with 28 d mortality. Multivariate Cox regression revealed that lung ultrasound score of area 1-2 was the independent risk factor of 28 d mortality, as well as APACHE Ⅱ score and lactate level. The Kaplan-Meier curve found that the more severe the lesion in area 1-2, the lower the survival rate at 28 d.
      Conclusion  Lung ultrasound score of area 1-2 in patients with shock and on mechanical ventilation may be a predictor of poor prognosis at 28 d.

     

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