根据氧气和指数对急性呼吸困扰综合征进行不同严重程度的分类
Shin-Hwar Wu1, Chew-Teng Kor2,3, Shu-Hua Chi4
1Division of Critical Care Internal Medicine, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 50006, Taiwan.
氧和指数 (OSI) 有效地分层成人急性呼吸窘迫综合征 (ARDS) 严重程度并预测死亡率,为临床使用提供了柏林定义的有价值的替代方案.
科学领域:
- 临界护理医学 临界护理医学
- 肺部病理学 肺部病理学
- 呼吸系统医学 呼吸系统医学
背景情况:
- 柏林定义是急性呼吸窘迫综合征 (ARDS) 诊断和分层的标准.
- 氧和指数 (OSI) 在儿科ARDS中表现有希望,但其在成年人中的实用性尚未确立.
- 预测ARDS死亡率对于患者管理和资源分配至关重要.
研究的目的:
- 调查氧和指数 (OSI) 对成年ARDS严重程度分层的有效性.
- 将基于OSI的ARDS分类与已建立的柏林定义进行比较.
- 评估基于OSI的ARDS严重程度与患者死亡率的关联.
主要方法:
- 对379名入侵通风成年ARDS患者进行了回顾性研究.
- 根据OSI值将ARDS患者分为轻度,中度和重度的分类.
- 相关性分析 (肯德尔的) 和生存分析 (卡普兰-梅尔曲线,危险比率),比较OSI和柏林的定义.
- 多变量分析以评估与死亡率的独立关联.
主要成果:
- 基于OSI的ARDS分类与柏林定义有很高的相关性 (肯达尔的tau=0.578,p<0.001).
- 卡普兰-梅尔曲线显示了OSI定义的严重程度组之间死亡率的显著差异 (p < 0.001).
- 基于OSI的严重ARDS与28天和90天的死亡率独立相关,与轻度相比,中度和严重组的危险率为2.39 (1.71-3.35).
结论:
- 本研究为成人ARDS提供了第一个基于OSI的分层.
- 对于成年人ARDS分类,OSI是柏林定义的可靠替代方案.
- 基于OSI的分层与成年患者的ARDS死亡率密切相关.
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