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呼吸机依赖风险评分对伴有呼吸衰竭的脓毒症/脓毒性休克存活患者延长机械通气的预测价值。

Ventilator Dependence Risk Score for the Prediction of Prolonged Mechanical Ventilation in Patients Who Survive Sepsis/Septic Shock with Respiratory Failure.

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.

出版信息

Sci Rep. 2018 Apr 4;8(1):5650. doi: 10.1038/s41598-018-24028-4.

Abstract

We intended to develop a scoring system to predict mechanical ventilator dependence in patients who survive sepsis/septic shock with respiratory failure. This study evaluated 251 adult patients in medical intensive care units (ICUs) between August 2013 to October 2015, who had survived for over 21 days and received aggressive treatment. The risk factors for ventilator dependence were determined. We then constructed a ventilator dependence (VD) risk score using the identified risk factors. The ventilator dependence risk score was calculated as the sum of the following four variables after being adjusted by proportion to the beta coefficient. We assigned a history of previous stroke, a score of one point, platelet count less than 150,000/μL a score of one point, pH value less than 7.35 a score of two points, and the fraction of inspired oxygen on admission day 7 over 39% as two points. The area under the curve in the derivation group was 0.725 (p < 0.001). We then applied the VD risk score for validation on 175 patients. The area under the curve in the validation group was 0.658 (p = 0.001). VD risk score could be applied to predict prolonged mechanical ventilation in patients who survive sepsis/septic shock.

摘要

我们旨在开发一种评分系统,以预测患有呼吸衰竭的脓毒症/脓毒性休克并存活超过 21 天且接受积极治疗的患者对机械通气的依赖。本研究评估了 2013 年 8 月至 2015 年 10 月期间在重症监护病房(ICU)接受治疗的 251 名成年患者,这些患者存活时间超过 21 天且接受了积极治疗。确定了导致呼吸机依赖的危险因素。然后,我们使用确定的危险因素构建了呼吸机依赖(VD)风险评分。VD 风险评分通过按比例调整至β系数的以下四个变量的总和来计算。我们将既往卒中史赋值为 1 分,血小板计数小于 150,000/μL 赋值为 1 分,pH 值小于 7.35 赋值为 2 分,入院第 7 天吸入氧分数大于 39%赋值为 2 分。在推导组中,曲线下面积为 0.725(p<0.001)。然后,我们将 VD 风险评分应用于 175 名患者进行验证。在验证组中,曲线下面积为 0.658(p=0.001)。VD 风险评分可用于预测脓毒症/脓毒性休克患者的机械通气延长。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05cf/5884833/4969c27d3cb5/41598_2018_24028_Fig1_HTML.jpg

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