休克指数与脓毒性休克患者病情严重程度的相关性及对预后的评估价值  

Correlation between shock index and severity of septic shock and its prognostic value

作　　者：吴爱萍[1] 王金柱[1] 韩芳[1] 倪银[2] Wu Aiping;Wang Jinzhu;Han Fang;Ni Yin(Department of Intensive Care Unit,Zhefiang Provincial People's Hospital,Hangzhou 310014,Zhejiang,China;Department of Hospital Infection Management,Zhefiang Provincial People's Hospital,Hangzhou 310014,Zhejiang,China)

机构地区：[1]浙江省人民医院重症医学科,浙江杭州310014 [2]浙江省人民医院医院感染管理科,浙江杭州310014

出　　处：《中华危重病急救医学》2018年第12期1141-1145,共5页Chinese Critical Care Medicine

基　　金：浙江省自然科学基金青年基金项目(LQ18H150002);浙江省医药卫生平台计划(2015RCB003).

摘　　要：目的探讨休克指数(SI)与脓毒性休克患者病情严重程度的相关性及其对预后的预测价值。方法选择2016年1月1日至2017年10月31日浙江省人民医院重症医学科(ICU)收治的127例脓毒性休克患者为研究对象,根据入院28d转归将患者分为生存组和死亡组。比较两组患者入院时的生命体征、实验室指标、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、液体复苏3h的乳酸清除率(LCR)以及入院时休克指数(SI1)和液体复苏3h休克指数(SI2)的差异;分析SI与APACHEⅡ、SOFA和LCR的相关性;绘制受试者工作特征曲线(ROC),评估SI对脓毒性休克患者预后的预测价值。结果127例患者中生存组52例(占40.9%),死亡组75例(占59.1%)。死亡组患者SI1、SI2、APACHEⅡ及SOFA评分均明显高于生存组[SI1:1.62±0.46比1.35±0.32,SI2:1.36±0.24比0.93±0.15,APACHEⅡ(分):17.5±4.0比13.6±3.5,SOFA(分):9.5±2.3比6.3±1.5],LCR明显低于生存组[(14.4±5.2)%比(28.6±8.6)%],差异均有统计学意义(均P<0.01)。相关性分析显示,SI1与APACHEⅡ(r=0.458,P=0.000)和SOFA(r=0.535,P=0.000)呈明显正相关,SI2与APACHEⅡ(r=0.624,P=0.000)和SOFA(r=0.656,P=0.000)也呈明显正相关,而SI1、SI2与LCR均呈明显负相关(r值分别为-0.348、-0.435,均P=0.000),可以显示SI2与APACHEⅡ、SOFA和LCR的相关性更好。ROC曲线分析显示,SI1预测脓毒性休克患者预后的ROC曲线下面积(AUC)为0.720[95%可信区间(95%CI)=0.620~0.831,P<0.05],当SI1=1.68时,其敏感度、特异度、约登指数、阳性预测值和阴性预测值分别为79.5%、65.6%、0.451、0.759和0.636;SI2预测脓毒性休克患者预后的AUC为0.826(95%CI=0.739~0.826,P<0.05),当SI2=1.37时,其敏感度、特异度、约登指数、阳性预测值和阴性预测值分别为85.7%、87.6%、0.733、0.893和0.902。结论与SI1相比,SI2与脓毒性休克患者的病情严重程度具有更好的相关性,且对患者预后预测的价值更大。Objective To discuss the correlation between shock index(SI)and severity and the values to forecast the prognosis in patients with septic shock.Methods 127 patients with septic shock admitted to intensive care unit(ICU)of Zhejiang Provincial People's Hospital from January 1st,2016 to October 31st,2017 were enrolled,and they were divided into survival group and death group according to the outcomes after 28-day hospitalized.The vital signs,laboratory indexes,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ),sequential organ failure assessment(SOFA),lactate clearance rate(LCR)of 3 hours after fluid resuscitation,and shock index on admission(SI1)and shock index of 3 hours after fluid resuscitation(SI2)were compared between the two groups.The correlation among SI and APACHE Ⅱ,SOFA,LCR was analyzed.The receiver operating characteristic curve(ROC)was drawn to evaluate the prognostic value of SI in patients with septic shock.Results A total of 127 patients were included,52 in survival group(40.9%)and 75 in death group(59.1%).The SI1,SI2,APACHE Ⅱ and SOFA in the death group were significantly higher than those in the survival group(SI1:1.62±0.46 vs.1.35±0.32,SI2:1.36±0.24 vs.0.93±0.15,APACHEⅡ:17.5±4.0 vs.13.6±3.5,SOFA:9.5±2.3 vs.6.3±1.5),and LCR was significantly lower than that in the survival group [(14.4±5.2)% vs.(28.6±8.6)%],with statistically significant differences(all P<0.01).The correlation analysis showed that SI1 was significantly positively correlated with APACHEⅡ(r=0.458,P=0.000)and SOFA(r=0.535,P=0.000),SI2 was also significantly positively correlated with APACHEⅡ(r=0.624,P=0.000)and SOFA(r=0.656,P=0.000),while SI1 and SI2 were significantly negatively correlated with LCR(r values were -0.348,-0.435,both P=0.000),and the SI2 were more remarkable.ROC curve analysis showed that the area under ROC curve(AUC)of SI1 for predicting the prognosis of septic shock was 0.720 [95% confidence interval(95%CI)= 0.620-0.831,P<0.05];when SI1=1.68,the sensitivity,specificity,Yoden index,positi

关 键 词：脓毒性休克 休克指数 急性生理学与熳性健康状况评分Ⅱ 序贯器官衰竭评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]