早产儿难治性脓毒性休克结局预测指标分析  

The predicting indices for the outcome of refractory septic shock in preterm infants

作　　者：林颖仪 廖海玲 马冬菊 王越[1] 钟隽镌 张静[1] 莫镜[1] 叶秀桢[1] 帅春[1] Lin Yingyi;Liao Hailing;Ma Dongju;Wang Yue;Zhong Junjuan;Zhang Jing;Mo Jing;Ye Xiuzhen;Shuai Chun(Department of Neonatology,Guangdong Women and Children Hospital,Guangzhou 510010,China)

机构地区：[1]广东省妇幼保健院新生儿科,广州510010

出　　处：《中华新生儿科杂志（中英文）》2023年第3期157-161,共5页Chinese Journal of Neonatology

基　　金：广州市市科技项目(202102080378)。

摘　　要：目的探讨血管活性药物评分(vasoactive-inotropic score,VIS)、液体超负荷(fluid overload,FO)、血乳酸水平对早产儿难治性脓毒性休克结局的预测价值。方法选择2016年1月至2021年12月广东省妇幼保健院新生儿科诊断难治性脓毒性休克并需要使用氢化可的松治疗的早产儿进行回顾性分析,根据疾病转归分为预后良好组和预后不良组,并按不同胎龄进行分析,通过受试者工作特征(receiver operating characteristic,ROC)曲线分析氢化可的松治疗前VIS最大值、FO和血乳酸均值与难治性脓毒性休克患儿结局的关系,计算ROC曲线截点值,得出各指标对早产儿难治性脓毒性休克结局的预测效能。结果共纳入50例难治性脓毒性休克早产儿,预后良好组20例,预后不良组30例。两组胎龄<32周早产儿使用氢化可的松治疗前VIS最大值、FO和血乳酸均值比较,差异均无统计学意义(P>0.05);胎龄32~36周早产儿中预后不良组使用氢化可的松治疗前VIS最大值[(56.1±15.7)比(37.1±12.9)]、FO(%)[108.2(78.6,137.7)比55.5(10.3,100.7)]和血乳酸均值(mmol/L)[8.3(4.6,12.0)比4.8(-0.8,10.5)]均高于预后良好组,差异有统计学意义(P<0.05),其中血乳酸均值ROC曲线下面积最大,截点值为4.1 mmol/L,约登指数为1.732。结论VIS、FO和乳酸水平不能判断极早产儿难治性脓毒性休克结局,但有助于中晚期早产儿的病情判断,其中血乳酸均值预测效能最佳。Objective To study the predictive value of vasoactive-inotropic score(VIS),fluid overload(FO)and lactate level for the outcome of preterm infants with refractory septic shock.Methods Preterm infants diagnosed with refractory septic shock and required hydrocortisone treatment in our Department from January 2016 to December 2021 were analyzed retrospectively.Preterm infants were assigned into three gestational age groups(<28 weeks,28-31 weeks,32-36 weeks).According to the outcome of the disease,the children were further divided into good prognosis group and poor prognosis group.The relationship between the maximum VIS,FO and the mean lactic acid before hydrocortisone and the outcome of refractory septic shock was analyzed by receiver operating characteristic(ROC)curve,the cut-off point of ROC curve was calculated to obtain the predictive efficacy of the three indicators for the outcome of refractory septic shock in preterm infants.Results A total of 50 preterm infants with refractory septic shock and received hydrocortisone treatment were enrolled,including 20 in the good prognosis group and 30 in the poor prognosis group.There were no significant differences in the maximum VIS,FO and mean lactic acid before hydrocortisone treatment between the two groups of gestational age of<32 weeks(P>0.05).The maximum VIS,FO and mean lactic acid of gestational age of 32-36 weeks in the poor prognosis group were higher than those in the good prognosis group,VIS:56.1±15.7 vs.37.1±12.9,FO(%):108.2(78.6,137.7)vs.55.5(10.3,100.7),and mean lactic acid(mmol/L):8.3(4.6,12.0)vs.4.8(-0.8,10.5),all P<0.05.The area under the ROC curve of the mean lactic acid was the largest,the cut-off value was 4.1 mmol/L,and the Youden index was 1.732.Conclusions VIS,FO and lactate level are difficult to be used for determining the outcome of refractory septic shock in preterm infants of<32 weeks.While the mean lactic acid has the best predictive performance in preterm infants of 32-36 weeks.

关 键 词：脓毒性休克 氢化可的松 血管活性药物评分 液体管理 乳酸 

分 类 号：R722.6[医药卫生—儿科]