摘要/Abstract
摘要： 目的 ·分析肺血管通透性指数（ pulmonary vascular permeability index，PVPI）和降钙素原（ procalcitonin，PCT）水平对感染性休克相关的急性呼吸窘迫综合征（ ARDS）病情严重程度及预后的评估价值。方法 ·对 2016年 1月 1日—12月 31日南通大学附属医院重症医学科收治的 100例 ARDS患者的病例资料进行回顾性分析。记录患者性别、年龄、感染部位、急性生理学及慢性健康状况评分 Ⅱ（APACHE Ⅱ评分）、序贯器官功能衰竭评分（ SOFA评分）等临床资料，以及血清 PCT水平和首次脉搏指示连续心排血量（PiCCO）监测的血流动力学参数。将感染性休克相关 ARDS患者分成轻、中、重度组，并根据 28 d预后分为生存组和死亡组；比较各组间各项指标的差异，评价 PVPI和 PCT对感染相关 ARDS的严重程度及预后的预测价值。结果 ·感染性休克相关的 ARDS组患者 PVPI及 PCT水平明显高于非感染性休克相关 ARDS组，差异均有统计学意义（均 P0.000）；随着 ARDS加重， PVPI、PCT数值依次递增； PVPI在不同程度感染性休克相关的 ARDS患者间比较，差异有统计学意义（ P0.000）。Pearson 相关分析结果显示： PVPI与 APACHE Ⅱ评分、 SOFA评分均呈正相关（ r值分别为 0.554和 0.431，均 P0.000）；PCT分别与 APACHE Ⅱ评分、 SOFA评分呈正相关（ r值分别为 0.313和 0.320，均 P0.004）。PVPI联合 PCT诊断感染性休克相关 ARDS的受试者工作特征（ ROC）曲线下面积最大。结论 · PVPI能够评估感染性休克相关的 ARDS患者的病情严重程度， PCT及 PVPI对感染性休克相关的 ARDS患者预后有一定的评估价值，PVPI联合 PCT对感染性休克相关 ARDS的早期诊断有较好的预测作用。
关键词: 肺血管通透性指数, 降钙素原, 急性呼吸窘迫综合征, 感染性休克
Abstract:
Objective · To analyze the assessment value of pulmonary vascular permeability index (PVPI) and procalcitonin (PCT) levels to the severity and prognosis of acute respiratory distress syndrome (ARDS) associated with septic shock. Methods · Clinic data of 100 ARDS patients admitted to Affiliated Hospital of Nantong University was analyzed retrospectively. The clinical data was collected as follows: gender, age, infection site, acute physiology, chronic health evaluation Ⅱ (APACHE Ⅱ ), sequential organ failure (SOFA) score, serum PCT level, and hemodynamic parameters which were monitoredpulse indicator continuous cardiac output (PiCCO). Patients with septic shock associated with ARDS patients were divided into mild, moderate and severe groups. The patients were divided into survival group and death group according to the 28-day prognosis, and the differences in the parameters between two groups were analyzed, to evaluate PVPI and PCT in predicting the severity and prognosis of septic shock associated ARDS. Results · There were significant differences in PVPI and PCT between ARDS group associated with septic shock and not (P0.000). PVPI and PCT increased with the severity of ARDS, and there was a statistically significant difference between the ARDS groups in different degrees of PVPI (P0.000). Pearson correlation analysis showed that PVPI was positively correlated with APACHE Ⅱ score and SOFA score (r0.554, P0.000; r0.431，P0.000), and PCT was positively correlated with APACHE Ⅱ score and SOFA score (r0.313, P0.004; r0.320, P0.004). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve of the prognosis of ARDS patients with sepsis was significantly higher than those of the two groups. Conclusion · PVPI can assess the severity of ARDS in patients with septic shock, and PVPI and PCT are predictive factors of prognosis. The combination of PVPI and PCT contributes to early stage diagnosis of ARDS associated with septic shock.
Key words: pulmonary vascular permeability index, procalcitonin, acute respiratory distress syndrome, septic shock
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