重症肺部感染并发脓毒症预后影响因素及评估方法  

Influencing factors for prognosis of severe pulmonary infection complicated with sepsis and assessment measures

作　　者：赵润杨 孟泳 王东[1] 王艳梅 候从岭 雷小婷 ZHAO Run-yang;MENG Yong;WANG Dong;WANG Yan-mei;HOU Cong-ling;LEI Xiao-ting(Second Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan 450002,China)

机构地区：[1]河南中医药大学第二附属医院肺病科,河南郑州450002

出　　处：《中华医院感染学杂志》2020年第15期2311-2315,共5页Chinese Journal of Nosocomiology

基　　金：全国名老中医药专家传承工作室建设基金资助项目(国中医药办规财发【2012】27号)。

摘　　要：目的探究血清过氧化脂质(Lipid peroxide,LPO)检测联合急性生理学与慢性健康状况Ⅱ(Acute physiology and chronic health evaluation,APACHEⅡ)评分、多器官功能障碍(Multiple organ dysfunction syndrome,MODS)评分在重症肺部感染合并脓毒症患者预后评估中的价值。方法回顾性收集2015年6月-2019年6月河南中医药大学第二附属医院ICU收治的125例重症肺部感染合并脓毒症患者的临床资料,依据生存情况将其分为病死组46例与生存组79例。入院时测定血清LPO含量,收集包括APACHEⅡ评分、MODS评分数据等在内的各项临床资料,并进行统计分析。结果与生存组比较,病死组发生急性肾损伤者占比、APACHEⅡ评分、MODS评分及血清LPO、降钙素原(Procalcitonin,PCT)含量高,24 h乳酸清除率(Lactate clearance rate,LCR)、氧合指数(Oxygenation index,PO2/FIO2)低(P<0.05)。Cox多因素回归分析显示APACHEⅡ评分、MODS评分、血清LPO和PCT含量、24 h LCR及PO2/FIO2是28 d内死亡的危险因素(P<0.05)。Pearson相关分析显示血清LPO含量与APACHEⅡ评分、MODS评分正相关(P<0.05)。血清LPO、APACHEⅡ评分、MODS评分单一项目及三项联合预测28 d内死亡的受试者工作特征(Receiver operating characteristic,ROC)曲线下面积分别为0.684、0.743、0.763及0.900,确定最佳阈值后三项联合预测28 d内死亡的的敏感性、特异性为86.95%、82.28%,高于任意单一项目检测。结论重症肺部感染合并脓毒症患者预后影响因素有多种,其中血清LPO与APACHEⅡ评分、MODS评分密切相关,且其联合APACHEⅡ评分、MODS评分对评估预后有重要价值。OBJECTIVE To investigate the value of serum lipid peroxidase(LPO)detection combined with acute physiology and chronic health evaluation(APACHE II)score and multiple organ dysfunction syndrome(MODS)score in the prognosis evaluation of patients with severe pulmonary infection complicated with sepsis.METHODS The clinical data of 125 patients with severe pulmonary infection complicated with sepsis admitted to the Second Affiliated Hospital of Henan University of Traditional Chinese Medicine from Jun.2015 to Jun.2019 were retrospectively enrolled.They were divided into the death group(46 cases)and the survival group(46 cases)according to the situation of survival.The content of serum LPO was measured at admission,and various clinical data including APACHE II score and MODS score were collected and statistically analyzed.RESULTS Compared with the survival group,the proportion of patients with acute kidney injury,APACHE II score,MODS score,contents of serum LPO and procalcitonin(PCT)were significantly higher,whereas 24 h lactate clearance rate(LCR)and oxygenation index(PO2/FIO2)were significantly lower in the death group(P<0.05).Cox multivariate regression analysis showed that APACHE II score,MODS score,contents of serum LPO and PCT,24 h LCR and PO2/FIO2 were risk factors for death within 28 days(P<0.05).Pearson correlation analysis showed that serum LPO content was positively correlated with APACHE II score and MODS score(P<0.05).The areas under the receiver operating characteristic(ROC)curves of serum LPO,APACHE II score or MODS score alone and combined prediction for death within 28 days were 0.684,0.743,0.763 and 0.900.After the optimal threshold was determined,the sensitivity and specificity of the combined prediction of the three indexes for death within 28 d(86.95%and 82.28%)were significantly higher than that of any other single index.CONCLUSION There are many factors influencing the prognosis of patients with severe pulmonary infection and sepsis.Serum LPO was closely related to APACHE II score and MODS score.T

关 键 词：过氧化脂质 急性生理学与慢性健康状况Ⅱ评分 多器官功能障碍评分 重症肺部感染 脓毒症 预后 

分 类 号：R563.1[医药卫生—呼吸系统]