超声心输出量监测在慢性阻塞性肺疾病急性加重期机械通气患者预后评估中的价值

刘明宗; 罗仁杰; 陈雪梅

doi:10.16016/j.2097-0927.202107094

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超声心输出量监测在慢性阻塞性肺疾病急性加重期机械通气患者预后评估中的价值

临床医学 | 更新时间：2026-01-09

- 超声心输出量监测在慢性阻塞性肺疾病急性加重期机械通气患者预后评估中的价值
- Prognotic value of ultrasonic cardiac output monitoring for mechanically ventilated patients with AECOPD
- 陆军军医大学学报 2022年44卷第2期页码：182-189
- 作者机构：
  
  1.400016 重庆，重庆医科大学附属第一医院急诊科
  2.610100成都，四川省医学科学院，四川省人民医院东院ICU
- 作者简介：
  
  [陈雪梅，E-mail: 1557451771@qq.com CHEN Xuemei, E-mail: 1557451771@qq.com
- 基金信息：
- DOI：10.16016/j.2097-0927.202107094
  中图分类号： R445.1;R563.807;R605.973
- 收稿：2021-07-14，
  
  修回：2021-09-28，
  
  纸质出版：2022-01-30
- 稿件说明：
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刘明宗, 罗仁杰, 陈雪梅. 超声心输出量监测在慢性阻塞性肺疾病急性加重期机械通气患者预后评估中的价值[J]. 陆军军医大学学报, 2022,44(2):182-189.

Mingzong LIU, Renjie LUO, Xuemei CHEN. Prognotic value of ultrasonic cardiac output monitoring for mechanically ventilated patients with AECOPD[J]. Journal of Army Medical University, 2022, 44(2): 182-189.
刘明宗, 罗仁杰, 陈雪梅. 超声心输出量监测在慢性阻塞性肺疾病急性加重期机械通气患者预后评估中的价值[J]. 陆军军医大学学报, 2022,44(2):182-189. DOI： 10.16016/j.2097-0927.202107094.

Mingzong LIU, Renjie LUO, Xuemei CHEN. Prognotic value of ultrasonic cardiac output monitoring for mechanically ventilated patients with AECOPD[J]. Journal of Army Medical University, 2022, 44(2): 182-189. DOI： 10.16016/j.2097-0927.202107094.

摘要

目的

探讨超声心输出量监测仪(ultrasonic cardiac output monitor

USCOM)监测的指标对慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease

AECOPD)机械通气患者的预后评估价值。

方法

采用回顾性队列研究，收集2017年6月至2020年12月四川省人民医院东院重症加强治疗病房收治的121例AECOPD机械通气患者的临床资料，采集患者机械通气第1天的USCOM指标，计算急性生理学和慢性健康状况评分(APACHE Ⅱ)，随访患者28 d生存率。采用多因素Logistic回归分析28 d死亡的独立预测因素，建立28 d死亡预测模型，采用受试者工作特征曲线(ROC)评价预测效果；应用Kaplan-Meier生存曲线及log-rank检验验证死亡风险预测效能。

结果

多因素Logistic回归分析显示APACHE Ⅱ评分与心输出量(cardiac output，CO)是患者28 d死亡的独立预测因素(

0.05)，CO联合APACHE Ⅱ评分建立AECOPD机械通气患者28 d死亡预测模型: logit(P)=-0.319+0.136 ×(APACHE Ⅱ评分)-0.933×(CO

L/min)。ROC曲线分析显示: APACHE Ⅱ评分、CO、CO联合APACHE Ⅱ评分预测模型预测患者28 d死亡的ROC曲线下面积分别为0.729、0.724和0.815；其截断值及相对应的灵敏度和特异度分别为14.5(82.6%

56.1%)、3.35(56.5%

84.7%)和0.163(87.0%

70.4%)。Kaplan-Meier生存曲线提示，低CO组患者生存率低于高CO组患者，CO指标联合APACHE Ⅱ评分预测模型高概率组患者生存率低于低概率组患者(

0.05)。

结论

USCOM监测的CO指标及CO联合APACHE Ⅱ评分建立的预测模型对AECOPD机械通气患者28 d死亡具有较好的预测价值。

Abstract

Objective

To investigate the value of indicators from ultrasound cardiac output monitor (USCOM) combined with clinical data for prognosis assessment in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Methods

A retrospective cohort study was performed on 121 AECOPD patients using mechanical ventilation admitted to the ICU of East Branch of Sichuan Provincial People's Hospital from June 2017 to December 2020. Their clinical data were collected

including the hemodynamic indicators of the USCOM and laboratory data on the first day of mechanical ventilation. Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score was calculated. All patients were followed up to 28 d. Multivariate logistic regression analysis was used to screen the independent predictors of 28-day death in order to establish a prediction model. Receiver operating characteristic (ROC) curve was employed to evaluate the predictive effect of the model. Kaplan-Meier analysis was adopted to estimate survival

and log-rank test was used to evaluate differences between groups.

Results

Logistic regression analysis showed that APACHE Ⅱ score and cardiac output (CO) were independent predictors of 28-day mortality in mechanically ventilated patients with AECOPD (

0.05). Predictive model combined CO index and APACHE Ⅱ score for 28-day mortality was established as follows: logit(P)=-0.319+0.136×(APACHE Ⅱ score)-0.933×(CO

L/min). The area under ROC of APACHE Ⅱ score

CO index and combined predictive model to predict 28-day mortality were 0.729

0.724 and 0.815

respectively. The optimal cutoff value

sensitivity and specificity of APACHE Ⅱ score were 14.5

82.6% and 56.1%

3.35

56.5% and 84.7% for CO index

and 0.163

87.0% and 70.4% for combined predictive model

respectively. Kaplan-Meier survival curve showed CO

3.35 L/min and the value of combined predictive model ≥0.163 were predictors for poor prognosis.

Conclusion

CO index monitored by USCOM and the predictive model combined CO index and APACHE Ⅱ score are of good predictive values for 28-day mortatlity in mechanically ventilated patients with AECOPD

and indicators monitored by USCOM combined with APACHE Ⅱ score have important predictive value for the patients.

关键词

Keywords

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