有创动脉血压监测改善脓毒症患者的预后  

Invasive arterial blood pressure monitoring improves the prognosis of patients with sepsis

作　　者：张云[1] 秦凤霞[1] 黄小菲[1] 胡星星[1] 倪海滨[1] Zhang Yun;Qin Fengxia;Huang Xiaofei;Hu Xingxing;Ni Haibin(Department of Emergency,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210000,China)

机构地区：[1]南京中医药大学附属中西医结合医院急诊科,南京210000

出　　处：《中华急诊医学杂志》2022年第2期217-222,共6页Chinese Journal of Emergency Medicine

基　　金：江苏省卫健委项目(ZDB2020032)。

摘　　要：目的评估有创动脉血压(Invasive blood pressure,IBP)监测对脓毒症患者预后的影响。方法收集MIMIC-Ⅳ数据库中脓毒症患者,根据是否行IBP监测分为IBP组和无创血压监测(NIBP)组。运用单因素分析和临床相关性筛选变量进行多元logistic回归模型,倾向性匹配评分(PSM)和逆概率加权(IPTW)调整组间混杂因素并稳健研究结论,logistic回归分析IBP和结局的关系。亚组分析评价IBP开始时间和持续时间的不同对结局的影响。结果IBP组和NIBP组相比28 d病死率低(OR=0.54,95%CI 0.46~0.62,P<0.001),经过PSM和IPTW后结论稳健。对IBP开始时间<24 h,24 h~48 h,>48 h进行logistic回归分析提示IBP开始时间<24 h组与主要研究结论一致(OR=0.42,95%CI:0.36~0.49,P<0.001),经PSM和IPTW后关系依旧稳健。IBP持续时间不同(≤1 d,≤2 d,≤3 d,≤4 d,>4 d)均显示IBP组与下降的28 d病死率相关,具有统计学意义。结论IBP与脓毒症患者28 d病死率下降具有相关性,且最佳IBP时间是24 h内。Objective To evaluate the effect of invasive arterial blood pressure(IBP)monitoring on the prognosis of patients with sepsis.Methods Patients with sepsis from the MIMIC-Ⅳdatabase were collected and divided into IBP and non-invasive blood pressure monitoring(NIBP)groups according to whether IBP monitoring was performed.Baseline variables that were considered clinically relevant or showed a univariate relationship with the outcome were entered into a multivariate logistic regression model as covariates.Propensity score matching(PSM)and inverse probability of treatment weighing(IPTW)were used to adjust confounders to ensure the robustness of findings.Subgroup analysis were conducted to evaluate the effect of differences in IBP onset and duration on outcome.Results The 28-day mortality is lower in IBP group compared with NIBP group(OR=0.54,95%CI 0.46-0.62,P<0.001),the conclusion maintain robust after PSM and IPTW.Then we conducted a series of logistic regression regarding to different initial IBP time(<24 h,24 h-48 h,>48 h)and the initial IBP time within 24 h showed the same results compared to primary outcoms(OR=0.42,95%CI:0.36-0.49,P<0.001).IBP duration varied(≤1day,≤2days,≤3days,≤4days,>4days)all showed a statistically significant association with decreased 28-day mortality in the IBP group.Conclusions IBP is associated with decreased 28-day mortality in patients with sepsis,and the optimal time of IBP is within 24 hours.

关 键 词：有创动脉血压监测 脓毒症 MIMIC-Ⅳ数据库 

分 类 号：R459.7[医药卫生—急诊医学]