摘要
目的探讨新生儿脓毒性休克液体超负荷(fluid overload, FO)发生的阈值及影响因素。方法回顾性分析2019年1月至2020年11月广东省妇幼保健院新生儿科收治的脓毒性休克患儿临床资料, 以预后不良为结局, 以休克24 h、48 h、72 h时的FO绘制受试者工作特征曲线, 计算对预后最有预测价值时间点的FO, 根据受试者工作特征曲线面积最大值选取FO截断值, 并以此分为FO<截断组值和FO≥截断值组, 分析FO的影响因素。结果共纳入152例有效病例, 根据受试者工作特征曲线面积最大值选取48 h FO截断值43.3%分为FO<43.3%组(116例)和FO≥43.3%组(36例)。FO≥43.3%组胎龄、出生体重、1 min Apgar评分、5 min Apgar评分、血小板计数、降钙素原、pH、白蛋白值低于FO<43.3%组, 休克评分、床边脓毒性休克评分(bedside septic shock scores, bSSS)、乳酸值、白细胞计数<5×109/L和输注白蛋白比例高于FO<43.3%组, 差异有统计学意义(P<0.05)。FO≥43.3%组持续肺动脉高压、严重颅内出血、脑室周围白质软化、急性肾损伤、严重脑损伤、多器官功能障碍、弥散性血管内凝血、28 d内全因死亡率高于FO<43.3%组, 差异有统计学意义(P<0.05)。Logistic回归分析结果显示, 与FO≥43.3%独立相关的危险因素为出生体重(OR=0.998, 95%CI 0.998~0.999, P<0.05)、pH(OR=0.018, 95%CI 0.000~0.990, P<0.05)及bSSS(OR=1.619, 95%CI 1.134~2.311, P<0.05)。根据受试者工作特征曲线面积得出相应指标截断值为出生体重1 830 g、pH 7.15、bSSS 0.5分。结论脓毒性休克新生儿48 h的FO对预后结局的预测价值最大, 截断值为43.3%, FO≥43.3%与不良结局相关;出生体重低、pH低、bSSS高的脓毒性休克新生儿易发生FO≥43.3%。
Objective To study the threshold of fluid overload(FO)and its risk factors in neonatal septic shock.Methods From January 2019 to November 2020,clinical data of infants with septic shock hospitalized in the neonatal department of our hospital were reviewed.With poor prognosis as the outcome,ROC curve was drawn based on 24 h(from the beginning of septic shock),48 h and 72 h FO value.FO cutoff value was determined as area under curve(AUC)reached maximum.Risk factors of FO were analyzed between FO<cutoff value group and FO≥cutoff value group.Results A total of 152 eligible cases were included and the cutoff value of 48 h FO was determined as 43.3%.116 cases were in FO<43.3%group and 36 cases were in FO≥43.3%group.FO≥43.3%group had smaller gestational age(GA),birth weight(BW),1 min Apgar score,5 min Apgar score and lower PLT,PCT,pH,and ALB level compared with FO<43.3%group.Meanwhile,FO≥43.3%group had significantly higher shock score,bedside septic shock scores(bSSS),lactic acid level,higher incidences of WBC<5×109/L and albumin infusion compared with FO<43.3%group.As for prognostic outcome,FO≥43.3%group had significantly higher incidences of neonatal persistent pulmonary hypertension,severe cerebral hemorrhage,periventricular leukomalacia,acute kidney injury,severe brain injury,multiple organ dysfunction syndrome,disseminated intravascular coagulation and 28 d all-cause mortality rate than FO<43.3%group(P<0.05).Logistic regression analysis showed risk factors associated with FO≥43.3%were BW(OR=0.998,95%CI 0.998~0.999,P<0.05),pH(OR=0.018,95%CI 0.000~0.990,P<0.05)and bSSS(OR=1.619,95%CI 1.134~2.311,P<0.05).The cutoff values were BW 1830 g,pH 7.15 and bSSS 0.5.Conclusions The 48 h FO with cutoff value of 43.3%has the highest predictive value for prognostic outcome in neonates with septic shock.FO≥43.3%is associated with more adverse outcomes.Infants with septic shock who have lower BW,lower pH and higher bSSS are more likely to develop FO≥43.3%.
作者
马冬菊
钟隽镌
林颖仪
帅春
王越
莫镜
张静
叶秀桢
Ma Dongju;Zhong Junjuan;Lin Yingyi;Shuai Chun;Wang Yue;Mo Jing;Zhang Jing;Ye Xiuzhen(Department of Neonatology,Guangdong Women and Children Hospital,Guangzhou 510000,China)
基金
广州市科技计划项目(202102080378)。
