急性呼吸窘迫综合征早期和中期肺死腔分数的预后价值。

Prognostic value of the pulmonary dead-space fraction during the early and intermediate phases of acute respiratory distress syndrome.

机构信息

Intensive Care Unit, Hospital Universitario Son Dureta, 07014, Palma de Mallorca, Illes Balears, Spain.

出版信息

Respir Care. 2010 Mar;55(3):282-7.

PMID:20196876

Abstract

BACKGROUND

Little is known about the alveolar dead-space fraction after the first week of acute respiratory distress syndrome (ARDS). We measured the dead-space fraction in the early phase (first week) and the intermediate phase (second week) of ARDS, and evaluated the association of dead-space fraction with mortality.

METHODS

We prospectively measured dead-space fraction and other variables in 80 intubated patients during the early phase of ARDS and in 49 patients during the intermediate phase. We used multiple logistic regression analysis to evaluate data. The primary outcome was in-hospital mortality.

RESULTS

In the early and intermediate phases the dead-space fraction was higher in patients who died than among those who survived (dead-space fraction 0.64 +/- 0.09 vs 0.53 +/- 0.11, P < .001, and 0.62 +/- 0.09 vs 0.50 +/- 0.10, P < .001, respectively). In both the early and intermediate phases the dead-space fraction was independently associated with a greater risk of death. For every dead-space-fraction increase of 0.05 the odds of death increased by 59% in the early phase (odds ratio 1.59, 95% confidence interval 1.18-2.16, P = .003) and by 186% in the intermediate phase (odds ratio 2.87, 95% confidence interval 1.36-6.04, P = .005). Age and Sequential Organ Failure Assessment score were also independently associated with a greater risk of death in both phases.

CONCLUSIONS

Increased alveolar dead-space fraction in the early and intermediate phases of ARDS is associated with a greater risk of death.

摘要

背景

急性呼吸窘迫综合征（ARDS）发病后第一周，肺泡死腔分数（alveolar dead-space fraction）知之甚少。我们测量了 ARDS 的早期（第一周）和中期（第二周）的死腔分数，并评估了死腔分数与死亡率的关系。

方法

我们前瞻性地测量了 80 例 ARDS 早期插管患者和 49 例 ARDS 中期患者的死腔分数和其他变量。我们使用多变量逻辑回归分析评估数据。主要结局是住院死亡率。

结果

在早期和中期，死亡患者的死腔分数高于存活患者（死腔分数分别为 0.64 ± 0.09 与 0.53 ± 0.11，P <.001，以及 0.62 ± 0.09 与 0.50 ± 0.10，P <.001）。在早期和中期，死腔分数均与死亡风险增加独立相关。早期阶段，死腔分数每增加 0.05，死亡的可能性增加 59%（比值比 1.59，95%置信区间 1.18-2.16，P =.003），中期阶段增加 186%（比值比 2.87，95%置信区间 1.36-6.04，P =.005）。年龄和序贯器官衰竭评估评分在两个阶段也与死亡风险增加独立相关。