简化急性生理评分-3在中重度急性呼吸窘迫综合征患者选择皮质醇激素治疗中的作用

doi:10.3969/j.issn.1006-7795.2021.06.003

首都医科大学学报 ›› 2021, Vol. 42 ›› Issue (6): 915-922.doi: 10.3969/j.issn.1006-7795.2021.06.003

• 重症医学基础与临床研究 • 上一篇下一篇

简化急性生理评分-3在中重度急性呼吸窘迫综合征患者选择皮质醇激素治疗中的作用

刘辉, 肖建国, 胡新, 王黎, 周飞虎^*

中国人民解放军总医院第一医学中心重症医学科, 北京 100853

收稿日期:2021-09-10 出版日期:2021-12-21 发布日期:2021-12-17
基金资助:
国家老年疾病临床医学研究中心课题(ZXD2002)。

The important role of simplified acute physiological score-3 in early corticosteroid treatment for patients with acute respiratory distress syndrome

Liu Hui, Xiao Jianguo, Hu Xin, Wang Li, Zhou Feihu^*

Critical Care Medicine Department, 1st Medical Center, Chinese People's Liberation Army of China General Hospital, Beijing 100853, China

Received:2021-09-10 Online:2021-12-21 Published:2021-12-17
Contact: * E-mail: feihuzhou301@126.com
Supported by:
National Geriatric Disease Clinical Medical Center (ZXD2002).

摘要/Abstract

摘要： 目的探讨简化急性生理评分-3(Simplified Acute Physiological Score-3, SAPS-3)在甄别可能从早期皮质醇激素治疗中获益的急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者的作用。方法分析电子重症医疗单元合作研究数据库(electronic intensive care unit collaborative research database, eICU-CRD)的临床资料。选取中重度ARDS患者,通过生存分析的方法明确了SAPS-3的诊断阈值,然后应用SAPS-3阈值将患者按病情严重程度分为2组。进一步应用倾向性评分匹配(propensity score matching analysis, PSMA)去除相关混杂因素后,分别比较2组患者在ARDS诊断3 d内应用皮质醇激素和没有应用皮质醇激素对于患者呼吸机使用时间的影响。结果筛选3 234名及时接受皮质醇激素治疗的ARDS患者,1 122名没有及时接受皮质醇激素治疗的患者。经过倾向性评分匹配后进行对比显示,在SAPS-3≤70的患者中,皮质醇激素治疗不影响患者的呼吸机辅助时间;在SAPS-3>70的患者中,接受早期皮质醇激素治疗的患者呼吸机使用时间明显缩短[(5.2±5.6) d vs (6.5±5.9) d, P<0.001],但是2组的病死率差异没有统计学意义。结论 SAPS-3有助于鉴别从早期皮质醇激素治疗中获益的呼吸机辅助ARDS患者。

关键词: 电子重症医疗单元合作研究数据库, 皮质醇激素, 急性呼吸窘迫综合征, 简化急性生理评分-3

Abstract: Objective To investigate the role of Simplified Acute Physiological Score-3 (SAPS-3) in spotting who was likely to benefit from early corticosteroid treatment in patients with acute respiratory distress syndrome (ARDS). Methods Electronic intensive care unit collaborative research database (eICU-CRD) was used to extract data about moderate or severe ARDS patients. After the cut-off value of SAPS-3 was identified, accordingly, the enrolled patients were divided into two groups. Propensity score matching analysis (PSMA) was used to remove confounding factors before comparing the effect of early corticosteroid treatment in ARDS patients. Results There were 3 234 ARDS patients with early corticosteroid treatment and 1 122 ARDS patients without this treatment. After propensity score matching analysis (PSMA), the data showed that ARDS patients with SAPS-3>70 had a shorter duration of mechanical ventilation after early corticosteroid treatment [(5.2±5.6) d vs (6.5±5.9) d, P<0.001), compared with the patients with SAPS-3≤70. There was no difference in mortality whether early corticosteroid treatment was applied or not. Conclusion The ARDS patients with SAPS-3>70 were likely to benefit from early corticosteroid treatment.

Key words: electronic intensive care unit collaborative research database, corticosteroid, acute respiratory distress syndrome, Simplified Acute Physiological Score-3

中图分类号:

刘辉, 肖建国, 胡新, 王黎, 周飞虎. 简化急性生理评分-3在中重度急性呼吸窘迫综合征患者选择皮质醇激素治疗中的作用[J]. 首都医科大学学报, 2021, 42(6): 915-922.

Liu Hui, Xiao Jianguo, Hu Xin, Wang Li, Zhou Feihu. The important role of simplified acute physiological score-3 in early corticosteroid treatment for patients with acute respiratory distress syndrome[J]. Journal of Capital Medical University, 2021, 42(6): 915-922.

参考文献

[1] Villar J, Ferrando C, Martínez D, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial[J]. Lancet Respir Med, 2020, 8(3): 267-276.
[2] Lewis S R, Pritchard M W, Thomas C M, et al. Pharmacological agents for adults with acute respiratory distress syndrome[J]. Cochrane Database Syst Rev, 2019, 7(7):CD004477.
[3] Mungan İ, Bektaş Ş,Altınkaya Çavuş M, et al. The predictive power of SAPS-3 and SOFA scores and their relations with patient outcomes in the surgical intensive care unit[J]. Turk J Surg, 2019, 35(2):124-130.
[4] 郭晓娟,田国祥,闫小妮,等. eICU合作研究数据库申请及数据提取流程[J]. 中国循证心血管医学杂志, 2019, 11(1): 6-9.
[5] Pollard T J, Johnson A E W, Raffa J D, et al. The eICU Collaborative Research Database, a freely available multi-center database for critical care research[J]. Sci Data, 2018, 5:180178.
[6] Keegan M T, Gajic O, Afessa B. Comparison of APACHE Ⅲ, APACHE Ⅳ, SAPS 3, and MPMOⅢ and influence of resuscitation status on model performance[J]. Chest, 2012, 142(4): 851-858.
[7] Nassar A P, Malbouisson L M, Moreno R. Evaluation of Simplified Acute Physiology Score 3 performance: a systematic review of external validation studies [J]. Crit Care, 2014, 18(3):R117.
[8] 杜斌. 急性呼吸窘迫综合征的柏林定义:究竟改变了什么? [J]. 首都医科大学学报, 2013, 34(2): 201-203.
[9] Matera M G, Rogliani P, Bianco A, et al. Pharmacological management of adult patients with acute respiratory distress syndrome[J]. Expert Opin Pharmacother, 2020, 21(17):2169-2183.
[10] Fan E, Brodie D, Slutsky A S. Acute respiratory distress syndrome: advances in diagnosis and treatment [J]. JAMA, 2018, 319(7):698-710.
[11] Ye Z, Wang Y, Colunga-Lozano L E, et al. Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis[J]. CMAJ, 2020, 192(27):E756-E767.
[12] Zhan Y, Shang J, Gu Y, et al. Efficacy of corticosteroid in patients with COVID-19: a multi-center retrospective study and meta-analysis[J]. J Med Virol, 2021, 93(7): 4292-4302.
[13] RECOVERY Collaborative Group, Horby P, Lim W S, et al. Dexamethasone in Hospitalized Patients with Covid-19[J]. N Engl J Med, 2021, 384(8):693-704.
[14] Menezes R C, Ferreira I B B, Carmo T A, et al. Are prognostic tools losing accuracy? Development and performance of a novel age-calibrated severity scoring system for critically ill patients[J]. PLoS One, 2020, 15(11):e0240793.
[15] Shadnia S, Zamani N, Hassanian-Moghaddam H, et al. Prognostic value of cortisol and thyroid function tests in poisoned patients admitted to toxicology ICU[J]. World J Emerg Med, 2018, 9(1):51-55.
[16] Meduri G U, Rochwerg B. Point: should corticosteroids be routine treatment in early ARDS? Yes[J]. Chest, 2021, 159(1):25-29.
[17] 董红建,谭捷.糖皮质激素联合参芪扶正注射液辅治重症社区获得性肺炎致ARDS患者效果观察及对血清炎性因子、血气指标影响[J].临床误诊误治,2019,32(11):25-29.
[18] Nicolaides N C, Kyratzi E, Lamprokostopoulou A, et al. Stress, the stress system and the role of glucocorticoids[J].
Neuroimmunomodulation, 2015, 22(1-2): 6-19.
[19] Mokra D, Mikolka P, Kosutova P, et al. Corticosteroids in acute lung injury: the dilemma continues[J]. Int J Mol Sci, 2019, 20(19):4765.
[20] Villar J, Confalonieri M, Pastores S M, et al. Rationale for prolonged corticosteroid treatment in the acute respiratory distress syndrome caused by coronavirus disease 2019[J]. Crit Care Explor, 2020, 2(4): e0111.
[21] Torres A, Sibila O, Ferrer M, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial[J]. JAMA, 2015, 313(7): 677-686.
[22] WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne J A C, Murthy S, et al. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis[J]. JAMA, 2020, 324(13): 1330-1341.
[23] Annane D, Pastores S M, Rochwerg B, et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017[J]. Intensive Care Med, 2017, 43(12): 1751-1763.
[24] Oh D K. Corticosteroids in acute respiratory distress syndrome: outcomes obscured by mortality[J]. Korean J Intern Med, 2021, 36(1):65-66.

简化急性生理评分-3在中重度急性呼吸窘迫综合征患者选择皮质醇激素治疗中的作用

The important role of simplified acute physiological score-3 in early corticosteroid treatment for patients with acute respiratory distress syndrome

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 4

编辑推荐

Metrics

本文评价

[1]	程卫, 隆云. 膈肌保护性通气的概念及进展[J]. 首都医科大学学报, 2022, 43(5): 740-746.
[2]	王玉妹, 王岩, 周益民, 徐珊珊, 杨燕琳, 张琳琳, 周建新. 基于慢吐气方法选择急性呼吸窘迫综合征模型呼气末正压的可行性[J]. 首都医科大学学报, 2021, 42(6): 903-908.
[3]	杜斌. 急性呼吸窘迫综合征的柏林定义:究竟改变了什么?[J]. 首都医科大学学报, 2013, 34(2): 201-203.
[4]	姜利;席修明;朱波. 应用肺复张法治疗肺内源性和肺外源性急性呼吸窘迫综合征的比较[J]. 首都医科大学学报, 2007, 28(5): 558-561.