| 熊 亮,于 杨,成爱玲,赵 廷.烧伤脓毒症患者并发 ARDS 预测模型的构建[J].中国烧伤创疡杂志,2024,(5):362~366. |
| DOI： |
| 中文关键词: 烧伤 脓毒症 急性呼吸窘迫综合征 危险因素 预测模型 |
| 英文关键词:Burns Sepsis Acute respiratory distress syndrome Risk factors Prediction model |
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| 中文摘要: |
| 【摘要】 目的 建立烧伤脓毒症患者并发急性呼吸窘迫综合征 (ARDS) 的预测模型。方法 选取2018年4月至2022年4月中国人民武装警察部队山东省总队医院收治的126例烧伤脓毒症患者作为研究对象, 收集患者性别、既往病史及现病史 (有无糖尿病、高血压、低氧血症等)、呼吸频率、是否合并 ARDS 以及入院 24 h 内急性生理学与慢性健康状况评分系统Ⅱ (APACHEⅡ) 评分、序贯器官衰竭 (SOFA) 评分、肺损伤预测评分 (LIPS)等资料, 并根据是否合并 ARDS 将其分为 ARDS 组和非 ARDS 组。采用多因素 Logistic 回归分析烧伤脓毒症患者并发 ARDS 的相关危险因素, 并根据分析结果构建预测模型。结果 126 例烧伤脓毒症患者中 37 例 (29.37%)并发 ARDS, 设为 ARDS 组; 89 例 (70.63%) 未并发 ARDS, 设为非 ARDS 组。单因素分析结果显示, ARDS 组合并有低氧血症与肺部感染、呼吸频率异常患者比例以及 APACHEⅡ评分、SOFA 评分、LIPS 均明显高于非ARDS 组 (χ2/ t = 45.628、50.603、14.244、8.225、10.526、9.590, P 均<0.001)。多因素 Logistic 回归分析结果显示, 合并有低氧血症与肺部感染以及 APACHEⅡ评分、SOFA 评分、LIPS 高是烧伤脓毒症患者并发 ARDS 的独立危险因素 ( 95% CI 为 3.512 ~ 27.823、1.893 ~ 12.279、1.738 ~ 9.126、1.481 ~ 11.418、1.672 ~ 12.012, P <0.001、P= 0.001、P= 0.001、P= 0.007、P= 0.003)。得出预测模型公式为 P = -2.318+1.289×低氧血症+1.573×肺部感染+1.382×APACHEⅡ评分+1.414×SOFA 评分+1.500×LIPS。受试者操作特征(ROC)曲线分析结果显示,预测模型曲线下面积为 0.895、敏感度为83.8%、特异度为 86.5%。结论 低氧血症、肺部感染、APACHEⅡ评分、SOFA评分及LIPS是烧伤脓毒症患者并发ARDS的影响因素, 据此建立的预测模型预测烧伤脓毒症患者是否并发 ARDS 的价值较高。 |
| 英文摘要: |
| 【Abstract】 Objective To establish a prediction model for the occurrence of acute respiratory distress syndrome (ARDS) in burn patients with sepsis. Methods 126 burn patients with sepsis, admitted to Shandong General Hospital of Chinese People’s Armed Police Force from April 2018 to April 2022, were selected as the research subjects and patients’ data were collected, including sex, past medical history, current medical history (with or without diabetes, hypertension, hypoxemia, etc), respiratory rate, with ARDS or not, and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, sequential organ failure assessment ( SOFA) score, and lung injury prediction score ( LIPS) within 24 h after admission. Based on whether complicated with ARDS, the patients were divided into ARDS group and non-ARDS group. Multivariate Logistic regression analysis was conducted to analyze the risk factors for the occurrence of ARDS in burn patients with sepsis, based on which a prediction model was constructed. Results Among the 126 burn patients with sepsis, 37 cases (29.37%) developed with ARDS were set as ARDS group, and the other 89 cases (70.63%) without the occurrence of ARDS were set as non-ARDS group. The results of the univariate analysis showed that the proportions of patients with hypoxemia and lung infection, abnormal respiratory rate, APACHE Ⅱ score, SOFA score, and LIPS in the ARDS group were significantly higher compared with the non-ARDS group ( χ2/ t = 45.628, 50.603, 14.244, 8.225,10.526 and 9.590, all P<0.001). Multivariate Logistic regression analysis showed that complicated with hypoxemia and lung infection, high levels of APACHE Ⅱ score, SOFA score and LIPS were independent risk factors for the occurrence of ARDS in burn patients with sepsis ( 95%CI: 3.512-27.823, 1.893-12.279, 1.738-9.126, 1.481-11.418, 1.672-12.012, P<0.001, P= 0.001, P= 0.001, P= 0.007, P= 0.003). The formula of the prediction model was P = -2.318+1.289×hypoxemia+1.573×lung infection+1.382×APACHE Ⅱ score+1.414×SOFA score+1.500×LIPS. The receiver oper-ating characteristic (ROC) curve showed that the area under the curve was 0.895, with the sensitivity being 83.8% and thespecificity being 86.5%. Conclusion Hypoxemia, lung infection, APACHE Ⅱ score, SOFA score, and LIPS are the influencing factors for the occurrence of ARDS in burn patients with sepsis, and the prediction model constructed based on these factors presented a high predictive value for the occurrence of ARDS in burn patients with sepsis. |
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