脉搏灌注指数对脓毒症伴发急性肾损伤患者短期预后的预测价值  

Predictive value of pulse infusion index in the short-term prognosis of patients with sepsis-induced acute kidney injury

作　　者：张珏 王思盼 陈南[1] 金钧[1] 李毅[1] Zhang Jue;Wang Sipan;Chen Nan;Jin Jun;Li Yi(Department of Critical Care Medicine,the First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu,China)

机构地区：[1]苏州大学附属第一医院重症医学科,江苏苏州215006

出　　处：《中华危重病急救医学》2023年第11期1195-1199,共5页Chinese Critical Care Medicine

基　　金：江苏省高等学校自然科学研究项目(20KJB320026);江苏省苏州市科技计划项目(SYS2019055)。

摘　　要：目的探讨脉搏灌注指数(PPI)对脓毒症伴发急性肾损伤(AKI)患者短期预后的预测价值。方法采用回顾性队列研究方法,分析2021年7月至2022年12月苏州大学附属第一医院重症监护病房(ICU)收治的脓毒症伴发AKI患者的临床资料。收集患者的年龄、性别、感染部位、基础疾病,入院时平均动脉压(MAP)、心率(HR),以及机械通气、血管活性药物使用情况和去甲肾上腺素(NE)用量等基本资料,入院24 h内实验室指标、序贯器官衰竭评分(SOFA)和PPI,同时记录患者ICU住院期间预后。比较不同预后两组患者临床资料的差异;采用Spearman相关法分析PPI与SOFA评分的相关性;采用二元多因素Logistic回归分析筛选脓毒症伴发AKI患者ICU住院期间死亡的独立危险因素;绘制受试者工作特征曲线(ROC曲线),评估PPI对脓毒症伴发AKI患者短期预后的预测效能。结果共纳入102例脓毒症伴发AKI患者,ICU住院期间存活70例,死亡32例,ICU病死率为31.4%。与存活组相比,死亡组患者SOFA评分、HR、降钙素原(PCT)、血肌酐(SCr)、血乳酸(Lac)及NE用量均明显升高〔SOFA评分(分):11.22±2.48比8.56±2.01,HR(次/min):103.80±12.47比97.41±9.73,PCT(μg/L):9.22(5.24,17.84)比6.19(3.86,7.71),SCr(μmol/L):163.2(104.7,307.9)比125.5(89.3,221.0),Lac(mmol/L):2.81(1.95,4.22)比2.13(1.74,2.89),NE用量(μg·kg-1·min-1):0.7(0.4,1.1)比0.5(0.2,0.6),均P<0.05〕,PPI则较存活组明显降低〔0.83(0.42,1.55)比1.70(1.14,2.20),P<0.01〕。Spearman相关性分析显示,以SOFA评分为标准,PPI与脓毒症伴发AKI患者病情严重程度密切相关(r=-0.328,P<0.05)。二元多因素Logistic回归分析显示,PPI〔优势比(OR)=0.590,95%可信区间(95%CI)为0.361~0.966,P=0.002〕、SOFA评分(OR=1.406,95%CI为1.280~1.545,P<0.001)、PCT(OR=2.061,95%CI为1.267~3.350,P=0.006)是脓毒症伴发AKI患者ICU住院期间死亡的独立危险因素。ROC曲线分析显示,PPI预测脓毒症伴发AKI患者ICU住院期间死亡的ROC曲线�ObjectiveTo investigate the predictive value of pulse infusion index(PPI)in the short-term prognosis of patients with sepsis-induced acute kidney injury(AKI).MethodsA retrospective cohort study was conducted.The clinical data of patients with sepsis-induced AKI admitted to intensive care unit(ICU)of the First Affiliated Hospital of Soochow University from July 2021 to December 2022 were enrolled.The basic information of the patients were collect,including age,gender,site of infection,underlying disease,mean arterial pressure(MAP)and heart rate(HR)at admission,as well as the use of mechanical ventilation and vasoactive drugs,and norepinephrine(NE)dosage.Laboratory indicators,sequential organ failure assessment(SOFA)score and PPI within 24 hours of admission were also recorded,and the patient's prognosis during ICU hospitalization was also recorded.The differences in clinical data between the patients of two groups with different prognosis were compared.Spearman correlation method was used to analyze the correlation between PPI and SOFA score.Binary multivariate Logistic regression analysis was used to screen independent risk factors for death during ICU hospitalization in sepsis patients with AKI.Receiver operator characteristic curve(ROC curve)was plotted to evaluate the predictive value of PPI for the short-term prognosis of patients with sepsis-induced AKI.ResultsA total of 102 patients with sepsis-induced AKI were enrolled,of which 70 patients in the survival group and 32 patients in the death group,with ICU mortality of 31.4.Compared with the survival group,SOFA score,HR,procalcitonin(PCT),serum creatinine(SCr),and NE dosage in the death group were significantly increased[SOFA score:11.22±2.48 vs.8.56±2.01,HR(bpm):103.80±12.47 vs.97.41±9.73,PCT(μg/L):9.22(5.24,17.84)vs.6.19(3.86,7.71),SCr(μmol/L):163.2(104.7,307.9)vs.125.5(89.3,221.0),Lac(mmol/L):2.81(1.95,4.22)vs.2.13(1.74,2.89),NE usage(μg·kg-1·min-1):0.7(0.4,1.1)vs.0.5(0.2,0.6),all P<0.05],while PPI was significantly lower than that in survival gr

关 键 词：脓毒症 急性肾损伤 脉搏灌注指数 预后 病死率 

分 类 号：R459.7[医药卫生—急诊医学] R692.5[医药卫生—治疗学]