动态肺顺应性、腹内压与俯卧位机械通气重症肺炎患者预后的相关性-现代医学

动态肺顺应性、腹内压与俯卧位机械通气重症肺炎患者预后的相关性

单位：1. 无锡市第五人民医院重症医学科, 江苏无锡 214000;
2. 无锡市第五人民医院急诊科, 江苏无锡 214000

分类号：R826

出版年·卷·期（页码）：2026·54·第五期（832-837）

摘要：

目的：探究动态肺顺应性、腹内压与俯卧位机械通气重症肺炎患者预后的相关性。方法：回顾性选取2022年9月至2025年1月本院收治的俯卧位机械通气重症肺炎患者为研究对象，入院28 d预后不良的患者61例为预后不良组，按1 ∶ 2比例选择122例预后良好的患者为预后良好组。收集患者基线资料、生命体征、病原学情况、氧合指数、动态肺顺应性、腹内压。采用多因素Logistic回归法分析俯卧位机械通气重症肺炎患者预后不良的独立危险因素；限制性立方样条图分析动态肺顺应性、腹内压与俯卧位机械通气重症肺炎患者预后的关系；评价两者单一及联合应用预测预后的价值。结果：Logistic回归分析显示，急性生理和慢性健康状况Ⅱ(APACHE Ⅱ)评分、腹内压、合并感染性休克为俯卧位机械通气重症肺炎患者预后不良的危险因素，动态肺顺应性为保护因素(P＜0.05)。校正了APACHE Ⅱ评分、合并感染性休克因素的影响后进行限制性立方样条图分析显示，随着动态肺顺应性的升高俯卧位机械通气重症肺炎患者预后不良风险显著降低，随着腹内压的增高患者预后不良风险显著增加(P＜0.05)。受试者工作特征(ROC)曲线显示，腹内压、动态肺顺应性联合预测俯卧位机械通气重症肺炎患者预后不良的曲线下面积(AUC)最高，且决策曲线分析显示，两者联合预测在阈值概率为0.3~0.7时临床效益良好。结论：动态肺顺应性、腹内压与俯卧位机械通气重症肺炎患者不良预后密切相关，二者联合检测可用于患者预后预测。

Objective: To explore the correlation of dynamic lung compliance and intra-abdominal pressure with prognosis in patients with severe pneumonia undergoing prone position mechanical ventilation. Methods: Patients with severe pneumonia undergoing prone position mechanical ventilation admitted to our hospital from September 2022 to January 2025 were retrospectively selected as study subjects. A total of 61 patients with poor prognosis within 28 days of admission were classified as poor prognosis group, and 122 patients with good prognosis were selected at a ratio of 1 ∶ 2 as good prognosis group. Baseline data, vital signs, etiological conditions, oxygenation index, dynamic lung compliance and intra-abdominal pressure of patients were collected. Multivariate Logistic regression was used to analyze the independent risk factors for poor prognosis in patients with severe pneumonia undergoing prone position mechanical ventilation. Restricted cubic spline analysis was used to analyze the relationship between dynamic lung compliance, intra-abdominal pressure and prognosis in patients with severe pneumonia undergoing prone position mechanical ventilation. The value of their individual and combined application in predicting prognosis was evaluated. Results:Logistic regression analysis showed that Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score, intra-abdominal pressure, and comorbid septic shock were risk factors for poor prognosis in patients with severe pneumonia undergoing prone position mechanical ventilation, while dynamic lung compliance was a protective factor(P<0.05). After adjusting for the effects of APACHEⅡ score and comorbid septic shock, restricted cubic spline analysis showed that the risk of poor prognosis in patients with severe pneumonia undergoing prone position mechanical ventilation significantly decreased with the increase of dynamic lung compliance, and the risk of poor prognosis significantly increased with the increase of intra-abdominal pressure(P<0.05). Receiver operating characteristic(ROC) curve showed that the area under the curve(AUC) of the combined prediction of intra-abdominal pressure and dynamic lung compliance for poor prognosis in patients with severe pneumonia undergoing prone position mechanical ventilation was the highest, and decision curve analysis showed that the combined prediction had good clinical benefit when the threshold probability was 0.3-0.7. Conclusion:Dynamic lung compliance and intra-abdominal pressure are closely related to poor prognosis in patients with severe pneumonia undergoing prone position mechanical ventilation, and their combined detection can be used for patient prognosis prediction.

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