重症肾综合征出血热休克患者临床特征分析及死亡风险模型的构建  

Analysis of clinical characteristics and construction of death risk model of severe patients with hemorrhagic fever with renal syndrome

作　　者：王天平 杜虹 赵英仁[1] 陈文静 胡海峰 詹家燚 李璟 连建奇 刘锦锋[1] WANG Tianping;DU Hong;ZHAO Yingren;CHEN Wenjing;HU Haifeng;ZHAN Jiayi;LI Jing;LIAN Jianqi;LIU Jinfeng(Department of Infectious Diseases,The First Affiliated Hospital of Xi’an Jiaotong University,710004,China)

机构地区：[1]西安交通大学第一附属医院感染科,西安710004 [2]空军军医大学第二附属医院感染科,西安710038

出　　处：《传染病信息》2023年第1期43-50,共8页Infectious Disease Information

基　　金：空军军医大学临床研究常规项目(2021LC2222);陕西省卫生健康重点支持项目(2022A011);空军军医大学第二附属医院科技创新发展基金临床研究重点项目(2019LCYJ002);陕西省自然科学基金项目(2020JM-394)。

摘　　要：目的 回顾性分析重症肾综合征出血热(hemorrhagic fever with renal syndrome, HFRS)休克患者的临床特征,并构建死亡风险模型。方法 纳入2008年12月—2019年1月空军军医大学第二附属医院感染科收治的308例实验室确诊的重症HFRS休克患者(包括重型与危重型)。采集患者性别、年龄、入院病日、住院时间、预后、发病季节、既往病史、合并症、连续性肾脏替代治疗(continuous renal replacement therapy, CRRT)和机械通气情况、液体负荷程度(入院后5 d内)、入院时实验室检查指标(血常规、肝肾功、电解质、凝血指标)等。依据患者预后不同,分为存活组和死亡组。分析2组上述指标的差异。应用单因素和多因素二元Logistic回归分析患者死亡的独立影响因素,并分别构建基于临床及实验室指标的死亡风险模型。结果 纳入患者中,存活233例,死亡75例。死亡组均为危重型,其入院时病日、住院时间短于存活组,入院时心率、呼吸频率高于存活组(P均<0.05)。死亡组既往存在高血压病者更多(P <0.05),病程中低氧血症、急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)发生率高于存活组(P均<0.05),入院时快速器官衰竭估计评分(quick-sequential organ failure assessment, qSOFA)=3分者更高,少尿期时长更短,3期重叠、难治性休克发生率、应用血管活性药物治疗率更高(P均<0.05),更易出现液体正平衡(P <0.05)。死亡组首次CRRT持续时间、无创及有创通气持续时间均短于存活组,有创通气率显著高于存活组(P均<0.05)。死亡组入院时血小板分布宽度(platelet distribution width, PDW)、平均血小板体积、大型血小板比率、血红蛋白、血清Ca2+、纤维蛋白原水平均低于存活组,AST、ALT水平高于存活组,凝血酶原时间(prothrombin time, PT)、活化部分凝血活酶时间长(P均<0.05)。多因素统计分析显示,合并ARDS、难治性休克、行有创通气是患者Objective To retrospectively analyze the clinical characteristics of the severe shock patients with hemorrhagic fever with renal syndrome(HFRS) and construct death risk models. Methods Three hundred and eight HFRS patients with laboratory-confirmed severe HFRS(including severe-type and critical-type), admitted to the second affiliated Hospital of Air Force Medical University from December 2008 to January 2019, were included. The parameters such as sex, age,the day on admission, length of hospital stay, prognosis, the season of onset, past medical history, comorbidities, invasive treatment such as continuous renal replacement therapy(CRRT) and mechanical ventilation, fluid load within 5 days after admission,laboratory parameters on admission such as blood routine, liver and kidney function, electrolytes and coagulation were collected.The patients were divided into a survival group and a death group according to the prognosis. The differences referred to the parameters mentioned above between the two groups were analyzed, and univariate and multivariate binary logistic regression was used to analyze the independent death influential factors, and death risk models based upon the clinical and laboratory parameters were constructed respectively. Results Of the patients enrolled, 233 cases survived and 75 cases died. The death group was all critical-type patients, and their days on admission and length of hospital stay were shorter than those of the survival group, and their heart rates and respiratory rates on admission were higher than those of the survival group(P <0.05). There were more patients with previous hypertension in the death group(P <0.05). The incidence of hypoxemia and acute respiratory distress syndrome(ARDS) was higher than that of the survival group(P <0.05), and also with shorter duration of the oliguric phase,higher incidence of the quick-sequential organ failure assessment(qSOFA) score =3 on admission and overlap of the first three phases, higher incidence of refractory shock and treatment with va

关 键 词：肾综合征出血热 汉滩病毒 休克 临床特征 危险因素 模型 预后 难治性休克 

分 类 号：R512.8[医药卫生—内科学] R373.32[医药卫生—临床医学]