급성 폐손상 소아에서 초기 호흡지표의 변화와 예후와의 관계
The Relationship between Early Changes in Respiratory Parameters and the Prognosis in Children with Acute Lung Injury
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목적:호흡부전의 정도를 판정하는 지표로 P/F 비, OI, VI 등이 주로 이용되고 있으나 이들 호흡지표의 단일 판정보다 중환자실 입원 초기 치료에 따른 이들 지표의 변화가 예후와 보다 밀접한 연관이 있는지 알아보고자 하였다. 방법:2008년 1월부터 2009년 5월까지 서울아산병원 소아중환자실에 입원하여 급성 호흡부전으로 3일 이상 인공호흡치료를 적용받은 97명의 환아를 대상으로 입원 3일동안 호흡지표의 변화를 후향적으로 조사하여 예후와의 관계를 비교, 분석하였다. 결과:대상환자의 평균 연령은 3.7±5.0세, 남아는 58명, 여아는 39명이였으며, 사망률은 27.8%였다. 호흡지표 비교에서 생존군과 사망군의 초기 P/F 비, OI 그리고 VI는 유의한 차이를 보이지 않았으나, 생존군에서는 3일 동안 점차적으로 호흡지표들이 호전되는 양상을 보였고 사망군에서는 호흡지표들이 거의 변화를 보이지 않거나 악화되는 양상을 보였다. 초기호흡지표와 3일간의 호흡지표 변화의 ROC 곡선 비교에서도 ROC 곡선의 곡선밑면적에서 초기 호흡지표의 변화가 단일호흡지표 보다 유의하게 크게 나와 초기 호흡지표값 보다 호흡지표 변화값이 더 사망률을 예측하는데 유용함을 알 수 있었다. 결론:인공호흡기 치료를 적용 받은 환자에 있어 중환자실 입원 당시 호흡지표의 단일 판정보다 초기치료의 반응으로 나타나는 호흡지표들의 변화 양상이 환자의 예후와 밀접한 관련이 있는 것으로 보이며, 환자의 예후를 예측하고 치료를 결정하는데 있어 이런 초기 호흡지표들의 변화 양상을 평가하는 것이 도움이 될 것으로 사료된다.
Abstract
Purpose:The PaO2/FiO2 (P/F) ratio, oxygenation index (OI) and the ventilation index (VI) have been used as parameters of acute respiratory failure. This study was conducted to evaluate the relationship between the prognosis and early changes in the respiratory parameters in pediatric patients with acute lung injury (ALI). Methods:This is a retrospective study of 97 patients who had ventilator care for more than 3 days due to acute respiratory failure between January 2008 and May 2009 in PICU of Asan Medical Center. Results:The mean age was 3.7±5.0 years. This study included 58 males and 39 females. The mortality rate was 27.8%. There was no significant difference between the survivors and non- survivors in the initial P/F ratio, OI and VI. However, these parameters improved in the survivor group, unlike the non-survivor group whose parameters remained unchanged or worsened. When comparing the receiver operating characteristic (ROC) curve of the initial respiratory parameters and the changes in parameters for 3 days, the area under the ROC curves representing the changes in respiratory parameters for 3 days was significantly greater than that of initial respiratory parameters, thus indicating the parameter changes are more reliable predictors of mortality than the initial parameters. Conclusion:Early changes in respiratory parameters such as the P/F ratio, OI and VI, rather than initial parameters themselves, are more directly related to the prognosis of pediatric patients with ALI and would be useful in determining optimal treatment and predicting the prognosis.
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