摘要
目的 探讨异常体温及体温-时间曲线下面积对脓毒性休克患者预后的影响.方法 采用回顾性队列研究,选择2013年9月至2019年6月南京医科大学附属无锡人民医院因脓毒性休克入住重症医学科(ICU)的患者.在医院病例资料数据库中获取相关数据,如患者的性别、年龄、感染来源、ICU住院时间、序贯器官衰竭评分(SOFA)、21 d预后,ICU住院期间的最高体温(Tmax)、最低体温(Tmin)、体温极差(Tmax-min)以及入ICU 24 h内的最高体温(24 h Tmax)、最低体温(24 h Tmin)、体温极差(24 h Tmax-min).设置不同体温线T,计算体温高于T或低于T的体温-时间曲线下面积(A>T、A<T),以及不同温度段内所覆盖的面积(AT1-T2).根据21 d预后将患者分为好转组和死亡组,采用二元Logistic回归方法分析各体温指标对脓毒性休克患者21 d预后的影响.结果 共纳入635例脓毒性休克患者,21 d内好转476例,死亡159例.死亡组年龄、SOFA评分高于好转组,ICU住院时间短于好转组,而两组间性别、感染来源比较差异均无统计学意义.对性别、年龄、ICU住院时间、SOFA评分进行校正后,二元Logistic回归分析显示,Tmax的升高、Tmin的下降及Tmax-min的增加是脓毒性休克患者21 d死亡的危险因素〔Tmax :优势比(OR)=2.959,95%可信区间(95%CI)为1.620~5.398,P<0.001;Tmin :OR=0.329,95%CI 为 0.140~0.790,P=0.012;Tmax-min :OR=3.258,95%CI为1.840~5.471,P<0.001〕,而24 h Tmax、24 h Tmin、24 h Tmax-min与预后无关.A<36.0 ℃(OR=1.335,95%CI为1.102~1.745,P=0.014)、A>38.0 ℃(OR=1.041,95%CI为1.019~1.077,P=0.001)可使患者21 d相对死亡风险增加.设置体温线T在38.0~40.0 ℃时,A>T每增加1 ℃×h,患者21 d相对死亡风险相应增加4.1%~83.2%.结论 脓毒性休克患者住院期间体温低于36.0 ℃或高于38.0 ℃时,随着体温异常程度的增加和时间的延长,其21 d相对死亡风险增加.
Objective To observe the effects of abnormal body temperature and the area under temperature curve on the prognosis of patients with septic shock.Methods A retrospective cohort study was conducted.Patients with septic shock admitted to intensive care unit(ICU)of Wuxi People's Hospital Affiliated to Nanjing Medical University from September 2013 to June 2019 were enrolled.Data were obtained from the hospital case database,including the gender,age,infection source,the length of ICU stay,sequential organ failure assessment(SOFA)score,21-day prognosis;within the first 24 hours and throughout the period in ICU,the maximum temperature(24 h Tmax,Tmax),lowest temperature(24 h Tmin,Tmin),and the temperature range(24 h Tmax-min,Tmax-min)were aggregated.The area under temperature curve when body temperature was higher than T(A>T),or lower than T(A<T),and area section between T1 and T2(AT1-T2)was calculated respectively.Patients were divided into survival group and death group according to 21-day prognosis.Binary Logistic regression was used to analyze the effect of the above temperature indices on the prognosis.Results 635 septic shock patients were enrolled in the study.476 patients were survived and 159 died within 21 days.Compared with the survival group,the age,SOFA score were higher in the death group,while the length of ICU stay was shorter.There was no significant difference in gender or infection source between two groups.After adjusting for gender,age,the length of ICU stay and SOFA score,binary Logistic regression analysis showed that the increase of Tmax,decrease of Tmin,and increase of Tmax-min were risk factors for 21-day mortality[Tmax:odds ratio(OR)=2.959,95%confidence interval(95%CI)was 1.620-5.398,P<0.001;Tmin:OR=0.329,95%CI was 0.140-0.790,P=0.012;Tmax-min:OR=3.258,95%CI was 1.840-5.471,P<0.001],while 24 h Tmax,24 h Tmin and 24 h Tmax-min were not related to prognosis.A<36.0℃(OR=1.335,95%CI was 1.102-1.745,P=0.014),and A>38.0℃(OR=1.041,95%CI was 1.019-1.077,P=0.001)showed positive correlation with 21-d
作者
吴丁烨
董亮
高嵩
衡军锋
严洁
严正
陆士奇
Wu Dingye;Dong Liang;Gao Song;Heng Junfeng;Yan Jie;Yan Zheng;Lu Shiqi(Department of Emergency,the First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu,China;Department of Intensive Care,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,Jiangsu,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2019年第10期1219-1223,共5页
Chinese Critical Care Medicine
基金
江苏省无锡市科技成果与适宜技术推广项目(T201617)。
关键词
体温
发热
低体温
预后
脓毒性休克
Body temperature
Fever
Hypothermia
Prognosis
Septic shock
