摘要目的 探讨急性呼吸窘迫综合征(ARDS)患者机械功(MP)与肺部超声评分(LUS)的相关性及其对预后的评估价值.方法 选择2017年1月至2019年3月徐州医科大学附属连云港医院重症医学科(ICU)收治的行有创机械通气治疗的中重度ARDS患者,记录患者入ICU 0、24、48、72 h的MP和LUS评分.根据28 d预后将患者分为死亡组和存活组,分析患者MP和LUS评分的变化趋势以及组间差异;采用双变量相关分析MP与LUS评分以及二者与急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、氧合指数(PaO2/FiO2)、血乳酸(Lac)的相关性;采用受试者工作特征曲线(ROC)分析入ICU 0 h、72 h的MP和LUS评分对中重度ARDS患者28 d病死率的预测价值.结果 最终入选83例患者,28 d死亡32例,存活51例.入ICU时,死亡组Lac、APACHEⅡ及SOFA评分显著高于存活组,PaO2/FiO2显著低于存活组,其他基线指标差异均无统计学意义.随治疗时间的延长,存活组MP和LUS评分均呈明显下降趋势,而死亡组则呈显著上升趋势;死亡组0、24、48、72 h MP和LUS评分均明显高于存活组〔MP(J/min):20.97±3.34比17.20±4.71,21.56±3.48比16.87±3.85,22.72±2.97比16.13±3.52,25.81±3.46比15.24±3.78 ;LUS评分(分):19.17±3.31比16.27±4.28,20.28±3.65比15.27±3.23,21.53±4.32比13.63±3.71,23.94±3.82比12.53±2.94,均P＜0.05〕.入ICU 0、24、48、72 h MP与LUS评分均呈显著正相关(r值分别为0.547、0.577、0.754和0.783,均P＜0.01).入ICU首次MP和LUS评分均与SOFA评分、PaO2/FiO2呈显著正相关(r值分别为0.421、0.450和0.409、0.536,均P＜0.01),而与Lac和APACHEⅡ评分均无相关性.ROC曲线分析显示,0 h、72 h的MP、LUS评分对患者28 d病死率均有预测价值〔MP的ROC曲线下面积(AUC)分别为0.836、0.867,LUS评分分别为0.820、0.891,均P＜0.01〕.结论 中重度ARDS患者MP与LUS评分具有显著相关性;MP和LUS评分可早期对中重度ARDS患者28 d预后进行评估.

abstractsObjective To investigate the clinical correlations between mechanical power (MP) and lung ultrasound score (LUS), and analyze their evaluation value of prognosis in patients with acute respiratory distress syndrome (ARDS). Methods Patients with moderate to severe ARDS, who underwent invasive mechanical ventilation admitted to intensive care unit (ICU) of the Lianyungang Affiliated Hospital of Xuzhou Medical University from January 2017 to March 2019 were enrolled. The MP and LUS were recorded 0, 24, 48 and 72 hours after ICU admission. The patients were divided into death group and survival group according to the 28-day prognosis. The trends of MP and LUS in the two groups and their differences between groups were analyzed. Then the MP and LUS were analyzed by bivariate correlation analysis, and their correlations with acute physiology and chronic health evaluationⅡ (APACHEⅡ), sequential organ failure assessment (SOFA), oxygenation index (PaO2/FiO2), and blood lactate (Lac) were also analyzed. The predictive value of MP and LUS 0 hour and 72 hours in ICU for 28-day mortality in patients with moderate to severe ARDS was analyzed by receiver operating characteristic (ROC) curve. Results At the end, 83 patients were enrolled, with 32 died and 51 survived in 28-day. The Lac level, APACHEⅡ and SOFA in the death group were significantly higher than those in the survival group, while PaO2/FiO2 was significantly lower than the survival group, and the other baseline indicators were not statistically significant between the two groups. As the treatment time increased, the MP and LUS of the survival group showed a significant decrease trend, while the death group showed a significant upward trend. The MP and LUS of the death group 0, 24, 48, 72 hours after ICU admission were significantly higher than those of the survival group [MP (J/min): 20.97±3.34 vs. 17.20±4.71, 21.56±3.48 vs. 16.87±3.85, 22.72±2.97 vs. 16.13±3.52, 25.81±3.46 vs. 15.24±3.78; LUS: 19.17±3.31 vs. 16.27±4.28, 20.28±3.65 vs. 15.27±3.23, 21.53±4.32 vs. 13.63±3.71, 23.94±3.82 vs. 12.53±2.94, all P < 0.05]. There was a significant positive correlation between MP and LUS 0, 24, 48, 72 hours after ICU admission (r value was 0.547, 0.577, 0.754, and 0.783, respectively, all P < 0.01). The MP and LUS at 0 hour of ICU admission were significantly positively correlated with SOFA and PaO2/FiO2 (r value was 0.421, 0.450, and 0.409, 0.536, respectively, all P < 0.01), but no correlation with Lac and APACHEⅡ was found. The ROC curve analysis showed that the MP and LUS at 0 hour and 72 hours had predictive value for the 28-day mortality [the area under the ROC curve (AUC) of MP was 0.836, 0.867; and the AUC of LUS was 0.820, 0.891, all P < 0.01]. Conclusions There was a significant correlation between MP and LUS in patients with moderate to severe ARDS. The MP and LUS could be used early to evaluate the 28-day prognosis of patients with moderate to severe ARDS.