摘要
目的分析脓毒症休克患者预后的影响因素。方法回顾性分析2017年11月至2019年10月中国医学科学院北京协和医学院肿瘤医院重症医学科收治的103例脓毒症休克患者的临床资料。收集全部患者的临床资料,包括年龄、性别、合并疾病、转入ICU时急性生理学和慢性健康状况评分、简化急性生理学评分(simplified acute physiology score 3,SAPS3)、转入ICU时序贯器官衰竭评分、机械通气时间、是否接受肾替代治疗、住ICU时间、ICU死亡情况、住院时间等。根据患者住院期间是否死亡分为生存组与死亡组。统计两组患者确诊脓毒症休克第一个24h内应用血管活性药和强心药的最大剂量,分别赋分后计算血管活性药-强心药评分(vasoactive-inotropic score,VIS)。采用单因素和多因素logistic回归分析脓毒症休克患者院内死亡的影响因素,采用受试者工作曲线分析临床因素的预测能力。结果单因素分析结果显示,死亡组的SAPS3评分、序贯器官衰竭评分、心血管序贯器官衰竭评分、VIS评分均高于生存组,差异有显著性(P<0.05)。多因素分析结果显示,SAPS3评分(RR=1.062,95%CI 1.014~1.114,P=0.001)和VIS评分(RR=1.023,95%CI 1.007~1.039,P=0.005)是脓毒症休克患者院内死亡的独立危险因素。受试者工作曲线分析发现SAPS3评分和VIS评分预测脓毒症休克患者院内死亡的曲线下面积分别为0.804±0.063(95%CI 0.681~0.927,P=0.001)和0.856±0.039(95%CI 0.781~0.932,P<0.001)。截断值分析VIS评分取199分时,敏感性为81.8%,特异性为77.2%。结论SAPS3评分和VIS评分是脓毒症休克患者院内死亡的独立危险因素,且预测能力较好。
Objective To explore the factors affecting the prognosis of patients with septic shock.Method Data of 103 patients who were diagnosed as septic shock in department of intensive care medicine(ICU)between November 2017 and October 2019 were retrospectively collected and reviewed.Clinical data included age,gender,underlying disease,the acute physiology and chronic health evaluationⅡ(APACHEⅡ)and simplified acute physiology score 3(SAPS3)and sequential organ failure assessment(SOFA)scores on ICU admission,renal replacement therapy,mechanical ventilation time,the length of ICU stay,ICU mortality,the length of hospital stay,etc.According to whether the patients died or not,they were divided into the survival group and the death group.The maximum doses of vasoactive agents and inotropic agents in the first 24 hours after the diagnosis of septic shock were calculated.Vasoactive-inotropic score(VIS)was calculated as the sum of all vasoactive agents and inotropic agent of each patient according to the VIS scoring system.Univariate and multivariate logistic regression models were used to analyze the prognostic factors for hospital death in patients with septic shock.The receiver operating curve(ROC)was used to evaluate the application value of the clinical factors.Result Univariate analysis showed that the scores of SAPS3,SOFA,cardiovascular SOFA,VIS in death group were significantly higher than those in the survival group,respectively(P<0.05).Multivariable analysis found that SAPS3(P=0.011,RR=1.062,95%CI 1.014~1.114)and VIS(P=0.005,RR=1.023,95%CI 1.007~1.039)were independent factors in predicting the risk of hospital death.ROC analysis demonstrated that area under ROC were 0.804±0.063(95%CI 0.681~0.927,P=0.001)and 0.856±0.039(95%CI 0.781~0.932,P<0.001)for SAPS3 and VIS,respectively.The cut-off value of VIS was 199 with a sensitivity of 81.8%and specificity of 77.2%.Conclusion SAPS3 and VIS were independent factors in predicting the risk of hospital death in septic shock patients,and had good predictive ability.
作者
王海军
邢学忠
曲世宁
黄初林
王浩
袁振南
张昊
杨全会
Wang Haijun;Xing Xuezhong;Qu Shining;Huang Chulin;Wang Hao;Yuan Zhennan;Zhang Hao;Yang Quanhui(Department of Intensive Care Unit,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing100021,China)
出处
《中国医刊》
CAS
2020年第10期1089-1092,共4页
Chinese Journal of Medicine
