脓毒症患者早期测量中心静脉压与病死率的关系  

Association between early central venous pressure measurement and mortality in patients with sepsis: a data analysis of MIMIC-Ⅲ database

作　　者：陈晗[1] 龚书榕[1] 尚秀玲[1] 于荣国[1] Chen Han;Gong Shurong;Shang Xiuling;Yu Rongguo(Department of Critical Care Medicine,Provincial Clinical Medical College of Fujian Medical University,Fujian Provincial Hospital,Fuzhou 350001,Fujian,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院重症医学科,福州350001

出　　处：《中华危重病急救医学》2021年第7期786-791,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81701942)。

摘　　要：目的探讨早期测量中心静脉压(CVP)与脓毒症患者病死率的关系。方法基于重症监护医学信息数据库-Ⅲv1.4(MIMIC-Ⅲv1.4)中的健康数据,收集所有重症监护病房(ICU)成人脓毒症患者的资料,包括性别、年龄、合并症、生存时间、总住院时间、ICU住院时间、序贯器官衰竭评分(SOFA)、生命体征、入ICU首日实验室检查结果、血管活性药物使用情况、首日输液量和液体平衡、尿量、对肾脏替代治疗和机械通气的需求、脓毒症诊断以及在ICU中进行首次CVP测量的时间和数值。根据入ICU 6 h内是否测量CVP将患者分为早期测量和对照两组;根据获得首次CVP的时间将患者进一步分为≤3 h、4~6 h、7~12 h和12 h内未测量4个亚组。主要研究终点为28 d病死率。使用局部加权平滑(Lowess平滑)分析来探讨初始CVP值与病死率的关系;使用Kaplan-Meier生存分析及Log-Rank检验对28 d生存情况进行单变量分析;使用Cox回归模型进行多因素分析,评估CVP测量及时性与病死率的关系。结果共纳入4733例成人脓毒症患者,其中1673例在入ICU 6 h内测量了CVP,另外3060例未测量者作为对照组。CVP早期测量组除基础肾衰竭患者较对照组更少外,两组人口学特征和基础疾病比较差异均无统计学意义。CVP早期测量组入ICU 24 h内病情较对照组更重,表现为更高的血乳酸(Lac)水平和SOFA评分。CVP早期测量组28 d病死率显著低于对照组(34.2%比40.7%,P<0.01)。CVP早期测量组患者总住院时间更短,ICU住院时间更长,需要机械通气和血管活性药物的比例更高,24 h内液体入量和平衡量也更多。Lowess平滑分析显示,初始CVP与病死率之间呈"U"形关系,提示过高或过低的初始CVP均与不良预后相关。Kaplan-Meier生存分析显示,与12 h内未测量CVP患者相比,3 h内测量者28 d累积生存率明显升高(66.7%比59.1%;Log-Rank检验:χ^(2)=15.810,校正P<0.001);而4~6 h和7~12 h测量者28 d累积生Objective To investigate the association between early central venous pressure(CVP)measurement and mortality in patients with sepsis.Methods The adult patients with sepsis were identified from the health data of Medical Information Mart for Intensive Care-Ⅲv1.4(MIMIC-Ⅲv1.4).Data of all adult patients with sepsis were collected,including gender,age,comorbidities,length of survival,total length of hospital stay and intensive care unit(ICU)stay,sequential organ failure assessment(SOFA)score,vital signs,laboratory test results on the first day,vasoactive agents usage,fluid input,urine output and fluid balance on the first day,need for renal replacement therapy and mechanical ventilation,diagnosis of sepsis,and the time and value of the first CVP measurement in the ICU.Patients were divided into early measurement and control groups based on whether or not they had a CVP measurement within the first 6 hours of ICU stay.According to the time of the first CVP measurement,the patients were subdivided into four subgroups:≤3 hours,4-6 hours,7-12 hours and no measurement within 12 hours.The primary endpoint was 28-day mortality.The relationship between initial CVP and mortality was analyzed by Lowess smoothing method.Kaplan-Meier survival analysis and Log-Rank test were performed for univariate analysis.Cox regression analysis was performed for multivariate analysis to estimate the relationship between timeliness of CVP measurement and mortality.Results A total of 4733 sepsis patients were enrolled,1673 of whom had CVP measured within 6 hours of admission to the ICU,and the other 3060 patients served as the control group.There were no differences in demographic characteristics and underlying diseases between the two groups,except that the early CVP measurement group had less underlying renal failure compared with control group.The early CVP measurement group had higher lactic acid(Lac)levels and SOFA scores,indicating worse severity of disease as compared with control group.The 28-day mortality in the early CVP measure

关 键 词：中心静脉压 脓毒症 液体复苏 MIMIC-Ⅲ数据库 病死率 

分 类 号：R459.7[医药卫生—急诊医学]