脓毒性休克患者对特利加压素反应性的影响因素分析  

Analysis of influencing factors associated with responsiveness to terlipressin in septic shock patients

作　　者：余娇阳[1] Yu Jiaoyang(Intensive Care Unit,the Affiliated Hospital of Hangzhou Normal University,Hangzhou,Zhejiang 310015,China)

机构地区：[1]杭州师范大学附属医院重症监护室,310015

出　　处：《中国基层医药》2020年第1期73-76,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的分析脓毒性休克患者对特利加压素反应性的相关影响因素。方法回顾性分析2013年6月至2018年6月在杭州师范大学附属医院重症监护病房(ICU)接受儿茶酚胺治疗并加用特利加压素治疗至少6 h的脓毒性休克患者的临床资料,根据患者对特利加压素的反应性将其分为反应者或无反应者,分析加用特利加压素前的一些临床指标与患者对特利加压素反应性的关联。结果最终共纳入132例脓毒性休克患者,包括60例(45.45%)反应者与72例(54.54%)无反应者。与反应者相比,无反应者具有更高的ICU病死率与院内病死率(ICU病死率:20.00%比72.22%,χ2=35.734,P<0.001;院内病死率:81.67%比94.44%,P=0.028),以及更高的血乳酸中位数(2.73 mmol/L比5.22 mmol/L,Z=3.181,P=0.001)。多因素logistic回归分析显示加用特利加压素前的血乳酸水平是患者对特利加压素无反应的影响因素(比值比1.130,95%可信区间1.05~1.23,P=0.002)。接受者操作特征曲线分析显示加用特利加压素前的血乳酸水平预测无反应的曲线下面积为0.661。结论血乳酸水平可能对预测脓毒性休克患者对特利加压素反应性具有一定的临床价值。Objective To determine the relevant factors associated with the responsiveness of terlipressin in patients with septic shock.Methods From June 2013 to June 2018,the clinical data of patients with septic shock in the intensive care unit(ICU)of the Affiliated Hospital of Hangzhou Normal University who received catecholamine and treated with terlipressin for at least 6 h,were retrospectively analyzed.Then,the patients were categorized as either responders or non-responders according to their responsiveness to terlipressin.The potential associations between some clinical indicators before the addition of terlipressin and responsiveness to terlipressin were analyzed.Results A total of 132 patients with septic shock were included in this study,including 60cases(45.45%)responders and 72cases(54.54%)non-responders.Compared with responders,non-responders had significantly higher ICU mortality and hospital mortality(ICU mortality:20.00%vs.72.22%,χ2=35.734,P<0.001;hospital mortality:81.67%vs.94.44%,P=0.028)and higher median blood lactate(2.73 mmol/L vs.5.22 mmol/L,Z=3.181,P=0.001).Multivariate logistic regression analysis showed that blood lactate level before the addition of terlipressin was a risk factor for patients with no response to terlipressin(odds ratio 1.130,95%confidence interval 1.05-1.23,P=0.002).Receiver operating characteristic curve showed that the area under the curve of blood lactate before the addition of terlipressin was 0.661.Conclusion Blood lactate levels may be useful in predicting terlipressin responsiveness in patients with septic shock.

关 键 词：休克 脓毒性 乳酸 血管升压素类 医院死亡率 ROC曲线 Logistic模型 重症监护病房 

分 类 号：R45[医药卫生—治疗学]