脓毒性休克患者动脉血乳酸水平与入重症监护病房28 d后病死率的相关性  

Correlation of arterial blood lactic acid level in patients with septic shock and mortality 28 days after entering the intensive care unit

作　　者：张翠翠[1] 牛芳 吴琳[1] 张春灵 郝翠平 马爱英[1] 胡庆河[1] 高昶[2] Zhang Cuicui;Niu Fang;Wu Lin;Zhang Chunling;Hao Cuiping;Ma Aiying;Hu Qinghe;Gao Chang(The Third Department of Critical Care Medicine,Affiliated.Hospital of Jining Medical Universty,Jining 272030,China;Jining Medical Universty,Jining 272067,China)

机构地区：[1]济宁医学院附属医院重症医学三科,272030 [2]济宁医学院,272067

出　　处：《中国医师杂志》2021年第8期1164-1168,共5页Journal of Chinese Physician

基　　金：山东省医药卫生科技发展计划项目(2018WSB34007)。

摘　　要：目的探讨脓毒性休克患者人重症监护病房(ICU)动脉血乳酸(Lac)水平与28 d病死率的关系。方法回顾性分析2015年4月至2019年6月在济宁医学院附属医院重症医学科住院治疗的303例脓毒性休克患者的临床资料。根据人室血Lac水平将患者分为<4 mmol/L组(203例)、4〜10 mmol/L组(69例)、>10 mmol/L组(31例),分析患者基线特征。采用多元logistic回归分析影响脓毒性休克28 d病死率的独立影响因素。用受试者工作特征曲线(ROC)分析入室Lac水平对感染性患者28 d病死率的预测价值,并根据最佳截断值分组,绘制28 d Kaplan-Meier生存曲线。结果共纳入303例脓毒性休克患者,28 d死亡179例,28 d总病死率为59.08%。入室Lac<4 mmol/L组203例,入室Lac 4〜10 mmolA,组69例,入室Lac>10 mmol/L组31例。3组患者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)、氧合指数(Pa0_(2)/FI0_(2))、是否合并腹部感染、使用血管活性药物比例差异均有统计学意义(P<0.05)。多元logistic回归分析显示,脓毒性休克28 d病死率的独立影响因素为年龄、SOFA、使用机械通气、Lac水平。ROC曲线分析显示,脓毒性休克患者人室Kac预测28 d病死率的ROC曲线下面积(AUC)为0.6045(95%CI:0.5408〜0.6682),最佳截断值为3.55 mmol/L时,灵敏度为0.5084,特异度为0.7339,阳性似然比为1.9103,阴性似然比为0.6699。根据入室Lac最佳截断值将患者分为高乳酸组(≥3.55 mmol/L)和低乳酸组(<3.55 mmol/L),其28 d病死率分别为73.39%(91/124)和49.16%(88/179),Kaplan-Meier生存曲线显示,高乳酸组28 d累积存活率显著低于低乳酸组(P<0.001)。多元logistic回归分析显示,调整混杂因素后,入室Lac每增加1 mmol/L,28 d病死增加至1.22倍[优势比(OR)=1.22,95%可信区间(95%CI):1.08〜1.37,P=0.0014],高乳酸组28d病死率是低乳酸组的3.53倍(OR=3.53,95%CI:1.36〜7.09,P=0.0004)。结论在ICU脓毒性休克患者中,28 d病死率与入室后动脉血�Objective To investigate the relationship between the arterial blood lactic acid level after entering the intensive care unit(ICU)and the 28-day mortality of patients with septic shock.Methods The clinical data of 303 patients with septic shock hospitalized in the department of critical medicine of the Affiliated Hospital of Jining Medical College from April 2015 to June 2019 were analyzed retrospectively.According to the blood lactate(Lac)level,the patients were divided into<4 mmol/L group(n=203),4-10 mmol/L group(n=69)and>10 mmol/L group(n=31).The baseline characteristics of the patients were analyzed.Multiple logistic regression analysis was used to analyze the independent influencing factors of the 28-day mortality of patients with septic shock.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of the Lac level after entering the ICU for 28-day mortality,and Kaplan-Meier survival curve was performed according to the best cut-off value.Results A total of 303 patients with septic shock were included,with 179 died in 28 days,and the total mortality was 59.08%.There were 203,69,31 patients in Lac<4 mmol/L,4-10 mmol/L and>10 mmol/L group,respectively.There were significant differences in Acute Physiology and Chronic Health EvalutionⅡ(APACHEⅡ),Sequential Organ Failure Assessment(SOFA),oxygenation index(Pa0_(2)/Fi0_(2)),abdominal infection,the proportion of vasoactive drugs use among the three groups(P<0.05).Multiple logistic regression analysis showed that the independent influencing factor of the 28-day mortality of septic shock were age,SOFA,use of mechanical ventilation,lactic acid(Lac).ROC curve analysis showed that the area under the ROC curve(AUC)for predicting 28-day mortality of patients with septic shock was 0.6045(95%CI:0.5408-0.6682).When the optimal cut-off value was 3.55 mmol/L,the sensitivity was 0.5084,the specificity was 0.7339,the positive likelihood ratio was 1.9103 and the negative likelihood ratio was 0.6699.According to the best cut-off value of entranc

关 键 词：休克 脓毒性 乳酸 病死率 因素分析 统计学 

分 类 号：R459.7[医药卫生—急诊医学]