Offner Patrick J, Moore Ernest E
Department of Surgery, St. Anthony Central Hospital, Denver, CO 80204, USA.
J Trauma. 2003 Aug;55(2):285-9. doi: 10.1097/01.TA.0000078695.35172.79.
Lung protective ventilatory strategies using low tidal volume and high positive end-expiratory pressure (PEEP) have become standard practice. Such strategies, however, may invalidate measurement of lung injury severity by traditional methods that are based on plain chest radiograph findings, oxygenation, minute ventilation, lung compliance, and PEEP level, such as the Murray lung injury score (LIS). Many of these criteria are potentially therapy dependent and may change with different ventilatory strategies. The purpose of this study was to determine whether measurement of lung injury severity based simply on oxygenation criteria (PaO(2)/FIO(2)) was as accurate as the Murray LIS currently used in multiple organ failure (MOF) scoring.
Since 1992, trauma patients at high risk for developing MOF have been prospectively identified and MOF scores calculated daily. Pulmonary dysfunction is graded from 0 to 3 on the basis of a modified Murray LIS incorporating the aforementioned parameters. Lung injury severity was redefined using the PaO(2)/FIO(2) (P/F score): Grade 0 = >250; 1 = 175 to 250; 2 = 100 to 174; and 3 = <100. The maximum (worst) score using each was compared using logistic regression and receiver operating characteristic curve analysis.
Five hundred thirty-nine trauma patients had lung injury severity assessed using both LIS and P/F score. The mean P/F score was over twice the mean LIS (1.9 +/-.04 vs. 0.9+/-.04, p < 0.0001). In 28% of patients, the LIS and P/F score were identical, whereas in 71%, the P/F score was greater than the LIS. Both scores were significant predictors of mortality; however, receiver operating characteristic curve analysis showed that the P/F score was superior in predicting mortality (area under the curve, 0.74+/-.03 vs. 0.67+/-.04).
The P/F score is a simple method of quantifying lung injury severity in trauma patients that better predicts mortality compared with the more complicated modified Murray lung injury score currently in use. The P/F score should replace more complex and potentially therapy-dependent scores.
采用低潮气量和高呼气末正压（PEEP）的肺保护性通气策略已成为标准做法。然而，这些策略可能会使基于胸部X线平片表现、氧合、分钟通气量、肺顺应性和PEEP水平的传统方法（如默里肺损伤评分（LIS））对肺损伤严重程度的测量无效。这些标准中的许多都可能依赖于治疗，并且可能随不同的通气策略而改变。本研究的目的是确定仅基于氧合标准（PaO₂/FIO₂）测量肺损伤严重程度是否与目前用于多器官功能衰竭（MOF）评分的默里LIS一样准确。
自1992年以来，对有发生MOF高风险的创伤患者进行前瞻性识别，并每日计算MOF评分。根据纳入上述参数的改良默里LIS将肺功能障碍分为0至3级。使用PaO₂/FIO₂（P/F评分）重新定义肺损伤严重程度：0级 =>250；1级 = 175至250；2级 = 100至174；3级 = <100。使用逻辑回归和受试者工作特征曲线分析比较每种方法的最大（最差）评分。
539例创伤患者的肺损伤严重程度采用LIS和P/F评分进行评估。平均P/F评分是平均LIS的两倍多（1.9±0.04对0.9±0.04，p < 0.0001）。28%的患者LIS和P/F评分相同，而71%的患者P/F评分高于LIS。两种评分都是死亡率的显著预测指标；然而，受试者工作特征曲线分析表明，P/F评分在预测死亡率方面更优（曲线下面积，0.74±0.03对0.67±0.04）。
P/F评分是一种量化创伤患者肺损伤严重程度的简单方法，与目前使用的更复杂的改良默里肺损伤评分相比，能更好地预测死亡率。P/F评分应取代更复杂且可能依赖治疗的评分。
