复杂性腹腔感染的预后及并发ARDS的危险因素分析  

Prognosis analysis of complicated intra-abdominal infection and risk factor of concurrent ARDS

作　　者：林源希 宗晓龙[2] 李真玉[1] LIN Yuan-xi;ZONG Xiao-long;LI Zhen-yu(Department of Intensive Care Medicine;Department of Laboratory Science,The Second Hospital,Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院重症医学科,天津300211 [2]天津医科大学第二医院检验科,天津300211

出　　处：《天津医科大学学报》2022年第3期289-294,300,共7页Journal of Tianjin Medical University

基　　金：天津市高层次人才选拔培养工程“青年医学新锐”人才项目;天津市卫生健康科技项目(KJ20092);天津医科大学第二医院青年科研基金(2019ydey28)。

摘　　要：目的:探讨复杂性腹腔感染(cIAI)患者并发急性呼吸窘迫综合征(ARDS)的危险因素和预后因素。方法:回顾性分析2015年1月—2021年3月重症监护病房(ICU)收治的cIAI患者124例。根据进入ICU 1周内是否发生ARDS分为ARDS组和非ARDS组,其中ARDS组60例,非ARDS组64例;根据28 d生存状况为生存组和死亡组,其中生存组73例,死亡组51例。采集患者的入院基线资料,包括年龄、性别、吸烟史、饮酒史、感染部位、是否接受外科干预,收集入ICU第1个24 h内的相关实验室指标,包括白细胞计数(WBC)、降钙素原(PCT)、C反应蛋白(CRP)、血小板计数(PLT)、可溶性纤维蛋白单体/D二聚体(FDP/D-dimer)、白蛋白(ALB)、促凝血酶原时间(PT)、纤维蛋白原(FBG)、乳酸(Lac)、24 h液体平衡量,计算患者进入ICU 24 h内序贯器官衰竭评分(SOFA)、显性弥散性血管内凝血(DIC)评分进行单因素分析;建立多因素Logistic回归模型,分析cIAI患者并发ARDS的危险因素及死亡风险因素。绘制受试者工作特征(ROC)曲线,评价指标对cIAI继发ARDS和死亡结局的预测价值。结果:ARDS组年龄、血清ALB水平、SOFA、显性DIC评分、外科干预等指标与非ARDS组比较差异均有统计学意义(t=-3.673、-3.877、-7.364、-2.756,χ^(2)=6.115,均P<0.05);Logistic回归分析显示SOFA(OR=1.570,95%CI:1.277~1.9307)和显性DIC评分(OR=1.631,95%CI:1.063~2.503)是cIAI患者1周内并发ARDS的独立危险因素(均P<0.05),SOFA联合显性DIC评分预测ARDS的曲线下面积(AUC)为0.901(95%CI:0.86~0.97),灵敏度和特异度分别为93.2%和76.6%。生存组患者年龄、ALB、PLT、SOFA与死亡组比较差异均有统计学意义(t=-2.510、-4.741、-2.071、-6.390,均P<0.05);Logistic回归分析显示,SOFA(OR=1.408,95%CI:1.209~1.641)和ALB(OR=0.914,95%CI:0.858~0.973)是cIAI患者死亡的独立危险因素(均P<0.05),SOFA联合ALB预测28 d死亡率的AUC为0.864(95%CI:0.80~0.93),灵敏度和特异度分别为91.3%和72.7%。结论:SOFA联合Objective:To explore the risk factors and prognostic factors of acute respiratory distress syndrome(ARDS)in patients with complicated intra-abdominal infection(cIAI).Methods:A total of 124 cIAI patients admitted to ICU from January 2015 to March 2021 were analyzed retrospectively.According to whether ARDS occurred within one week after entering ICU,they were divided into ARDS group and non-ARDS group,including 60 cases in ARDS group and 64 cases in non ARDS group.According to the 28-day survival status,it was divided into survival group and death group,including 73 cases in survival group and 51 cases in death group.The baseline data of patients′admission were collected,including age,gender,smoking history,drinking history,infection site and whether they received surgical intervention.The relevant laboratory indexes in the first 24 hours of ICU were collected,including leukocyte count(WBC),procalcitonin(PCT),C-reactive protein(CRP),platelet count(PLT),soluble fibrin monomer/D-Dimer(FDP/D-dimer)Albumin(ALB),prothrombin time(PT),fibrinogen(FBG),lactic acid(LAC)and 24-hour fluid balance were calculated.SOFA score and explicit DIC score within 24 hours after they enter ICU were calculated for univariate analysis.The multivariate Logistic regression model was established to analyze the risk factors and death risk factors of ARDS in cIAI patients.The receiver operating characteristic curve(ROC curve)was drawn to evaluate the predictive value of indicators for ARDS and death after cIAI.Results:There were significant differences in age,serum albumin(ALB),SOFA score,overt DIC score,surgical intervention and other indicators between ARDS group and non-ARDS group(t=-3.673,-3.877,-7.364,-2.756,χ^(2)=6.115,all P<0.05).Logistic regression analysis showed that SOFA score(OR=1.570,95%CI:1.277-1.9307)and overt DIC score(OR=0.914,95%CI:0.858-0.973)were independent risk factors for ARDS in cIAI patients within one week(P<0.05).The AUC of SOFA score combined with overt DIC score for predicting ARDS was 0.901(95%CI:0.86-0.97),and

关 键 词：急性呼吸窘迫综合征 腹腔感染 序贯器官衰竭评分 显性DIC评分 白蛋白 

分 类 号：R563.8[医药卫生—呼吸系统]