胃肠道穿孔术后患者感染性休克死亡危险因素及预测效能分析  

Risk factors and predictive efficacy of death secondary to septic shock in patients after gastrointestinal perforation

作　　者：祁小荣 陈雅欢 沈明 QI Xiaorong;CHEN Yahuan;SHEN Ming(Changxing People's Hospital,Zhejiang 313100,China)

机构地区：[1]浙江省长兴县人民医院,长兴313100

出　　处：《浙江创伤外科》2024年第2期215-217,221,共4页Zhejiang Journal of Traumatic Surgery

摘　　要：目的探讨重症监护病房(ICU)胃肠道穿孔术后患者感染性休克死亡危险因素及预测效能。方法回顾性分析2019年12月至2023年6月本院ICU胃肠道穿孔术后患者感染性休克患者共80例临床资料,根据术后28 d是否死亡分为死亡组(25例)和存活组(55例),比较死亡组和存活组临床特征及实验室指标,采用Logistic回归模型评估ICU胃肠道穿孔术后患者感染性休克死亡独立危险因素,描绘ROC曲线分析上述独立危险因素用于ICU胃肠道穿孔术后患者感染性休克死亡风险预测临床效能。结果两组APACHE II评分、SOFA评分、血乳酸水平、中性粒细胞/淋巴细胞比值、平均血小板体积/血小板计数比值及淋巴细胞计数水平比较差异有统计学意义(P<0.05);Logistic回归模型多因素分析结果显示,高中性粒细胞/淋巴细胞比值、高平均血小板体积/血小板计数比值及低淋巴细胞计数水平均是ICU胃肠道穿孔术后患者感染性休克死亡独立危险因素(P<0.05);ROC曲线分析结果显示,中性粒细胞/淋巴细胞比值、平均血小板体积/血小板计数比值及淋巴细胞计数水平均可用于ICU胃肠道穿孔术后患者感染性休克死亡风险预测,AUC分别为0.69,0.72,0.67,且以上指标联合预测AUC为0.88,显著优于单一指标(P<0.05)。结论ICU胃肠道穿孔术后患者感染性休克死亡与高中性粒细胞/淋巴细胞比值、高平均血小板体积/血小板计数比值及低淋巴细胞计数水平有关;同时上述指标联合预测患者感染性休克死亡风险效能最佳。Objective To investigate the risk factors and predictive efficacy of death secondary to septic shock in patients after gastrointestinal perforation in ICU.Methods 80 septic shock patients after gastrointestinal perforation admitted to our hospital from December 2019 to June 2023 were retrospectively analyzed.All patients were divided into death group(25 cases)and survival group(55 cases)according to whether died in 28d after surgery.The clinical features and laboratory indicators of death group and survival group were compared and the independent risk factors of death from septic shock after gastrointestinal perforation in ICU were evaluated by Logistic regression model.ROC curves were drawn to analyze the clinical efficiency of the independent risk factors in predicting of death risk secondary to septic shock patients after gastrointestinal perforation surgery in ICU.Results There were significant differences in APACHEⅡscore,SOFA score,blood lactate level,neutrophil/lymphocyte ratio,mean platelet volume/platelet count ratio and lymphocyte count level between 2 groups(P<0.05).Multivariate analysis of Logistic regression model showed that neutrophil/lymphocyte ratio,mean platelet volume/platelet count ratio and lymphocyte count level were independent risk factors for death secondary to septic shock of patients after gastrointestinal perforation in ICU(P<0.05).ROC curve analysis results showed that neutrophil/lymphocyte ratio,mean platelet volume/platelet count ratio and lymphocyte count levels could be used to predict the death risk secondary to septic shock of patients after gastrointestinal perforation surgery in ICU,and the AUC was 0.69,0.72,0.67,respectively.The combined prediction AUC of the above indicators is 0.88,which was significantly better than that of the single indicator(P<0.05).Conclusion Death secondary to septic shock patients after gastrointestinal perforation in ICU was associated with high neutrophil/lymphocyte ratio,high mean platelet volume/platelet count ratio and low lymphocyte count leve

关 键 词：重症监护病房 胃肠道穿孔 手术 感染性休克 死亡 

分 类 号：R656.6[医药卫生—外科学]