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目的研究主要目标是评价北美-欧洲联合委员会(NAECC)关于儿科急性呼吸窘迫综合征(ARDS)定义的有效性;其次为评价用于诊断ARDS患儿的PaO2/FiO2值。设计回顾性队列研究地点儿童重症监护室研究对象1996年1月1日至2002年12月31日,儿童重症监护病房需机械通气、死亡并行尸检的34例患儿。测量与主要结果采用标准数据收集工具,通过病例复习,回顾性获得临床和胸片信息。数据包括NAECC关于ARDS的特定标准和人口学信息。计算敏感性、特异性、阳性预测值、阴性预测值和临床与病理诊断ARDS似然比。PaO2/FiO2诊断值由绘制接收器工作特性曲线和比较曲线下面积确定。NAECC定义的敏感性为80·7%(95%可信区间60-92%),特异性71·4%(95%可信区间30-95%),阳性预测值91·3%(95%可信区间70-98%),阴性预测值50·0%(95%可信区间20-78%),似然比为2·82。诊断ARDS,PaO2/FiO2<150较PaO2/FiO2>200有略高的特异性(但无显著差异,71%vs.86%,p=0·15),而敏感性相仿。结论本研究表明尽管NAECC定义似乎足以区分是否罹患ARDS,但确定诊断儿童ARDS的适宜PaO2/FiO2值,尚需大样本进一步研究。本研究数据提示,采用低于NAECC所推荐PaO2/FiO2值作为定义将更完善。然而,尚需前瞻性研究来证实我们的发现。
Purpose The main objective of the study was to evaluate the validity of the NAECC definition of pediatric acute respiratory distress syndrome (ARDS) and secondly to evaluate PaO2 / FiO2 values for the diagnosis of ARDS. Design Retrospective cohort study Location Children’s intensive care unit Study subjects From January 1, 1996 to December 31, 2002, 34 children admitted to the ICU with mechanical ventilation and died in parallel with autopsy. Measurements and Primary Results Using standard data collection tools, clinical and chest radiographs were retrospectively obtained through case review. The data includes NAECC specific criteria and demographic information about ARDS. The sensitivity, specificity, positive predictive value, negative predictive value, and clinical and pathological ARDS likelihood ratios were calculated. The PaO2 / FiO2 diagnostic value is determined by plotting the receiver operating characteristic and the area under the comparator. NAECC defined the sensitivity as 80.7% (95% confidence interval 60-92%), specificity 71.4% (95% confidence interval 30-95%), positive predictive value 91.3% (95% Confidence interval 70-98%), a negative predictive value of 50.0% (95% confidence interval 20-78%) and a likelihood ratio of 2.82. ARDS was diagnosed with a slightly higher specificity of PaO2 / FiO2 <150 than PaO2 / FiO2> 200 (but no significant difference, 71% vs. 86%, p = 0.15) with similar sensitivities. Conclusions This study shows that although the definition of NAECC appears to be sufficient to distinguish whether ARDS is affected or not, determining the appropriate PaO2 / FiO2 value for the diagnosis of ARDS in children still requires large sample size for further study. The data in this study suggest that the definition of PaO2 / FiO2 values lower than those recommended by NAECC will be better defined. However, prospective studies are still needed to confirm our findings.