ICU脓毒症患者液体平衡与预后的关系  

The relationship between fluid balance and prognosis in the septic patients in ICU

作　　者：颜瑶[1] 王小娟 刘璐 徐进步[1] YAN Yao;WANG Xiao-juan;LIU Lu;XU Jin-bu(Department of ICU,the Second People􀆳s Hospital of Lianyungang,Lianyungang,Jiangsu 222023,China)

机构地区：[1]连云港市第二人民医院重症医学科,江苏连云港222023

出　　处：《热带医学杂志》2020年第12期1600-1604,1613,共6页Journal of Tropical Medicine

基　　金：连云港市卫健委科研课题计划项目(QN1808)。

摘　　要：目的探讨重症监护室(ICU)脓毒症患者中累积液体平衡与预后的关系。方法分析2017年1月-2018年10月收治于连云港市第二人民医院重症医学科的164例脓毒症患者的临床病例资料。每日记录液体出入量并计算累积液体平衡,分别对入ICU后24、72 h的累积液体平衡以四分位数分为4组,采用Cox回归分析24、72 h各四分位组的累积液体平衡与院内死亡风险的关联。结果建立多变量Cox比例风险回归模型,校正年龄、性别、急性生理与慢性健康评分(APACHEⅡ评分)、序贯器官功能衰竭评分(SOFA评分)、病因、合并症、干预措施、感染部位、血管活性药物运用情况等因素后,分别以第一四分位组为参照,得出24 h第二、三、四组累积液体平衡的28 d院内死亡风险比(HR)(95%CI)分别为0.986(0.490~1.983)、0.614(0.239~1.581)、0.671(0.135~3.324),差异无统计学意义(P>0.05)。72 h第二、三、四组累积液体平衡的调整死亡风险比(HR)(95%CI)分别为3.835(1.249~11.776)、3.958(1.239~12.649)、8.410(2.604~27.161),差异有统计学意义(P<0.05)。结论进入ICU后72 h的累积液体平衡为脓毒症患者独立的死亡风险因素,更高的72 h累积液体平衡提示脓毒症患者预后不良。Objective To investigate the relationship between cumulative fluid balance and prognosis in patients with sepsis in intensive care unit(ICU).Methods Clinical data of 164 patients admitted to ICU of the Second People’ s Hospital of Lianyungang from January 2017 to October 2018 were retrospectively analyzed.The fluid intake and output were recorded daily and the cumulative fluid balance was calculated.Patients were divided into four groups according to the quartiles of cumulative liquid balance at 24 h and 72 h after admission to ICU.Cox regression analysis was used to analyze the relationship between the cumulative fluid balance in each quartile group at 24 h and 72 h and the in-hospital mortality risk.Results After adjustment for age,gender,APACHE II score,SOFA score,etiology,morbidities,interventions,site of infection and use of vasoactive drugs by using the Multivariate Cox proportional hazard regression model;taking the first quartile group as a reference,the HR values of the 28-day in-hospital mortality in the second,third,and fourth quartile groups of 24 h cumulative fluid balance were 0.986(0.490-1.983),0.614(0.239-1.581) and 0.671(0.135-3.324),respectively.There was no statistical significant difference(P>0.05).The HR values of the 28-day in-hospital mortality in the second,third,and fourth quartile groups of 72 h cumulative fluid balance were 3.835(1.249-11.776),3.958(1.239-12.649) and 8.410(2.604-27.161),respectively.There was a statistical significant difference(P<0.05).Conclusion Cumulative fluid balance at 72 h after admission to ICU was independently associated with the risk of mortality in patients with sepsis,and higher cumulative fluid balance at 72 h suggested poor prognosis in patients with sepsis.

关 键 词：脓毒症 液体平衡 预后 

分 类 号：R459.7[医药卫生—急诊医学]