Abstract: Objective　To explore the values of changes of heart rate and oxygenation index (PaO₂/FiO₂) after extracorporeal membrane oxygenation (ECMO) and scores of Acute Physiology and Chronic Health Evaluation (APACHEⅡ) and Sequential Organ Failure Assessment (SOFA) in prognostic prediction in patients with respiratory failure. Methods　A retrospective analysis was performed on 84 patients with respiratory failure who received ECMO treatment in Huangshi Central Hospital from February 2016 to February 2021, including 45 males and 39 females, aged (43.28±9.59) years. Taking 180 days after receiving ECMO support as the research endpoint, they were divided into a survival group (39 cases) and a death group (45 cases). The differences in heart rate, PaO₂/FiO₂, APACHEⅡ score, SOFA score, and clinical data were compared between the two groups; multivariate logistic regression analysis was used to analyze the factors affecting the patients' prognosis; the receiver operating characteristic curve (ROC) was used to analyze the predictive values of the above indicators on the patients' prognosis. The count data were tested by χ² test, and the measurement data were tested by independent sample t test. Results　The results of the multivariate logistic regression analysis showed that too short ECMO support duration, high APACHEⅡ score, high SOFA score, reduced PaO₂/FiO₂, and high heart rate were influencing factors of death (OR=0.802, 1.630, 2.010, 1.127, 1.132; all P<0.05). The results of the ROC analysis showed that the areas under curve (AUC) of heart rate, PaO₂/FiO₂, SOFA score, APACHEⅡ score, and combination of the four indicators in predicting patients' prognosis were 0.855, 0.858, 0.863, 0.857, and 0.991, respectively, indicating that the combination of the four indicators had a higher prognostic value than single indicator, with a sensitivity of 95.6% and a specificity of 100.0%, respectively. Conclusions　Changes in heart rate, PaO₂/FiO₂, SOFA score, and APACHEⅡ score are influencing factors of the prognosis in patients with respiratory failure after ECMO. At the same time, they have good predictive values for patients' prognosis. The combination of the four indicators can improve the accuracy and sensitivity in the prediction of prognosis for such patients, worthy of clinical promotion.

Key words: Respiratory failure, Extracorporeal membrane oxygenation, Heart rate, Oxygenation index, APACHEⅡ, SOFA

摘要： 目的　探究呼吸衰竭患者体外膜肺氧合（ECMO）治疗后心率、氧合指数（PaO₂/FiO₂）改变及急性生理学及慢性健康状况评分系统（APACHEⅡ）与序贯器官衰竭评估（SOFA）评分对预后的预测价值。方法　选取2016年2月至2021年2月在黄石市中心医院接受ECMO治疗的84例呼吸衰竭患者进行回顾性分析，男45例、女39例，年龄（43.28±9.59）岁。以接受ECMO支持后180 d为研究终点，分为生存组（39例）和死亡组（45例），比较两组心率、PaO₂/FiO₂、APACHEⅡ评分、SOFA评分及临床资料的差异；采用多因素logistic回归分析患者预后的影响因素；采用受试者工作特征曲线（ROC）分析以上指标对患者预后的预测价值。计数资料行χ²检验，计量资料行独立样本t检验。结果　多因素logistic回归分析结果显示，ECMO支持治疗时间过短、APACHEⅡ评分较高、SOFA评分较高、PaO₂/FiO₂降低及心率较快为患者死亡的影响因素（OR=0.802、1.630、2.010、1.127、1.132，均P<0.05）。ROC分析结果显示，心率、PaO₂/FiO₂、SOFA评分、APACHEⅡ评分及四项联合指标预测患者预后曲线下面积（AUC）分别为0.855、0.858、0.863、0.857、0.991，可知四项联合指标预测患者预后的价值高于单项指标，其灵敏度、特异度分别为95.6%、100.0%。结论　心率、PaO₂/FiO₂改变及APACHEⅡ与SOFA评分为呼吸衰竭患者ECMO治疗后预后的影响因素，同时对其预后有较好的预测价值，四项联合检测可以提高预测此类患者预后的准确度、灵敏度，值得在临床推广。

关键词: 呼吸衰竭, 体外膜肺氧合, 心率, 氧合指数, APACHEⅡ, SOFA