| 强离子隙在急性呼吸衰竭中的应用研究 |
| 投稿时间：2015-01-07 修订日期：2015-01-09 点此下载全文 |
| 引用本文：张忠源,章涛.强离子隙在急性呼吸衰竭中的应用研究[J].医学研究杂志,2015,44(10):64-69,82 |
| DOI：
10.11969/j.issn.1673-548X.2015.10.018 |
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| 基金项目:福建省卫生厅青年科研基金资助项目(2011-01-50) |
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| 中文摘要:目的 评估强离子隙(SIG)作为急性呼吸衰竭(ARF)患者死亡风险预测因子的临床价值。 方法 在测定血气、血pH值、电解质结果基础上,应用Stewart-Figge方法学的方程式计算SIG。 结果 (1)ARF发生率最高的基础疾病是急性呼吸窘迫综合征(占26%)和心源性肺水肿(占26%)。(2)ARF组T1与对照组相比,除Na+和PO4-无差别外,其余各指标差异均有统计学意义(P<0.01);但恢复组T2与对照组相比,各指标差异均无统计学意义。 (3)发生ARF的患者中,恢复组T1与死亡组T1检测各指标比较:两组间只有AG、SIG差异有统计学意义(P<0.01)。 (4)AG和SIG相关ROC曲线参数比较:SIG曲线下面积更大达到0.904,诊断准确性高;以15.4mmol/L作为AG的cut-off值,以6.77mmol/L作为SIG的cut-off值,计算相关ROC曲线参数,SIG的敏感度、Youden指数、阴性预测值、阴性似然比等参数优于AG。 结论 (1)在发生ARF之初,AG和SIG就可以较敏感地体现患者的复合酸碱紊乱状态,且AG和SIG有可能作为预测ARF患者死亡风险的预测因子,提示预后不良。(2)作为ARF患者死亡风险的预测因子,SIG优于AG。 (3)当cut-off值设为6.77mmol/L时,SIG的检测结果低于cut-off值,SIG的阴性似然比为0,敏感度高达1.000,如果诊断结果为阴性,能立刻排除患者死亡风险。 |
| 中文关键词:急性呼吸衰竭 血气分析 强离子隙 阴离子隙 ROC曲线 |
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| Evaluation of Strong Ion Gap in Patients with Acute Respiratory Failure |
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| Abstract:Objective To evaluate the probability that strong ion gap was selected as predictive factor of mortality in patients with acute respiratory failure. Methods SIG was calculated with the Stewart-Figge model, after determination of blood gas,blood pH,serum electrolytes. Results ①The incidence of acute respiratory distress syndrome and source pulmonary edema was 26% respectively in patients with ARF.②There was a significant difference in the values of K+、Cl-、HCO3-、AG、pH、ALB、SIG、Cr,lactic acid,PaCO2 and PaO2 between group T1 and control. However, there was no significant difference between recovery group T2 and control. ③There was a significant difference in the value of AG and SIG between the recovery group T1 and death group T1 from the patients with ARF. ④SIG was a better predictor than AG by the evaluation of ROC curve. Conclusions AG and SIG can reflect the worse condition of acid-base disturbance in patients with ARF sensitively at the first beginning. Meanwhile, SIG may be served as a predictor for risk of mortality in patients with ARF better than AG. |
| keywords:Acute respiratory failure Blood gas analysis Strong ion gap (SIG) Anion gap ROC curve |
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