电解质检测对血培养阳性脓毒症患者转归的影响  

Effect of electrolytes detection on outcome of sepsis patients with positive blood culture

作　　者：商蕾 杨靖娴[1] 刘雪凯[1] Shang Lei;Yang Jingxian;Liu Xuekai(Department of Clinical Laboratory,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院检验科,北京100049

出　　处：《实用检验医师杂志》2022年第3期303-306,共4页Chinese Journal of Clinical Pathologist

摘　　要：目的探讨静脉血电解质检测对血培养阳性脓毒症患者转归的影响。方法选择2019年1月—2021年10月航天中心医院收治的275例血培养阳性脓毒症患者作为研究对象,根据预后分为存活组(152例)和死亡组(123例)。患者均接受指南推荐的救治流程,采用常规生化方法检测血清电解质〔血钠(Na^(+))、血钾(K^(+))、血氯(Cl^(-))、血钙(Ca^(2+))、血镁(Mg^(2+))、血磷(P^(3+))、二氧化碳(CO_(2))、阴离子间隙(AG)〕。分析两组患者的电解质水平差异;根据正常参考值范围分为低值组、参考组、高值组,采用二元Logistic回归亚组分析明确患者死亡的危险因素。绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),评价该分组方式的效能。结果死亡组患者静脉血Na^(+)、Cl^(-)、Ca^(2+)、AG水平均明显高于存活组,P^(3+)水平明显低于存活组〔Na^(+)(mmol/L):143.69±8.47比138.85±6.03,Cl^(-)(mmol/L):104.90±9.53比103.60±6.32,Ca^(2+)(mmol/L):2.43±2.64比2.18±0.15,P^(3+)(mmol/L):0.95±0.58比0.98±0.37,AG(mmol/L):15.39±5.96比11.71±3.38,均P<0.05〕。二元Logistic回归亚组分析显示,以参考组为对照,静脉血K^(+)、Cl^(-)、Ca^(2+)、P^(3+)水平降低或升高均为患者死亡的危险因素。二元Logistic亚组回归预测模型ROC曲线的AUC为0.977,95%可信区间(95%CI)为0.963~0.991(P<0.05),该分组方式预测脓毒症患者死亡危险因素的效能较高。结论静脉血电解质检测对评估血培养阳性脓毒脓毒症患者的转归具有较高价值。Objective To investigate the effects of blood electrolytes detection on the prognosis of sepsis patients with positive blood culture.Methods The 275 patients with sepsis and positive blood culture admitted to Aerospace Center Hospital from January 2019 to October 2021 were selected as the study subjects and divided into survival group(152 cases)and death group(123 cases)according to prognosis.All patients accepted the treatment process recommended by guidelines,and used routine biochemical methods to detect serum electrolytes[blood sodium(Na^(+)),blood potassium(K^(+)),blood chlorine(Cl^(-)),blood calcium(Ca^(2+)),blood magnesium(Mg^(2+)),blood phosphorus(P^(3+)),carbon dioxide(CO_(2))and anion gap(AG)].The differences of electrolyte levels between two groups were analyzed.According to the reference range of electrolytes,they were divided into low value group,reference range group,and high value group.The risk factors of death in sepsis patients were determined by binary Logistic regression subgroup analysis.The performance of the grouping method was evaluated by reciever operator characteristic(ROC)curve and area under ROC curve(AUC).Results The levels of venous blood Na^(+),Cl^(-),Ca^(2+)and AG in death group were significantly higher than those in survival group,and the level of P^(3+)in death group was significantly lower than that in survival group[Na^(+)(mmol/L):143.69±8.47 vs.138.85±6.03,Cl^(-)(mmol/L):104.90±9.53 vs.103.60±6.32,Ca^(2+)(mmol/L):2.43±2.64 vs.2.18±0.15,P^(3+)(mmol/L):0.95±0.58 vs.0.98±0.37,AG(mmol/L):15.39±5.96 vs.11.71±3.38,all P<0.05].The results of binary Logistic regression subgroup analysis showed that using reference range group as control,the lower or higher levels of K^(+),Cl^(-),Ca^(2+)and P^(3+)were risk factors for death.The AUC of ROC curve of binary Logistic subgroup regression prediction model was 0.977,95%confidence interval(95%CI)was 0.963^(-)0.991(P<0.05).This grouping method was more effective in predicting death risk factors of spesis patients.Conclusions The ven

关 键 词：电解质 脓毒症 回归分析 

分 类 号：R459.7[医药卫生—急诊医学]