新生儿难治性脓毒性休克早期预测指标分析  

Early predictors of refractory septic shock in neonates

作　　者：钟隽镌 莫镜[1] 张静[1] 林颖仪 马冬菊 王越[1] 帅春[1] 叶秀桢[1] Zhong Junjuan;Mo Jing;Zhang Jing;Lin Yingyi;Ma Dongju;Wang Yue;Shuai Chun;Ye Xiuzhen(Neonatology Department,Guangdong Women and Children Hospital/Guangdong Neonatal ICU Medical Quality Control Center/Department of National Key Clinical Specialty Construction Project,Guangzhou 510000,China)

机构地区：[1]广东省妇幼保健院新生儿科/广东省新生儿重症医学专业质量控制中心/国家临床重点专科建设项目单位,广州510000

出　　处：《中华新生儿科杂志（中英文）》2024年第3期157-161,共5页Chinese Journal of Neonatology

基　　金：国家重点研发计划项目(2021YFC2701710)。

摘　　要：目的探讨新生儿难治性脓毒性休克的早期预测指标。方法选择2020年7月至2021年12月广东省妇幼保健院新生儿重症监护病房收治的脓毒性休克新生儿进行回顾性分析,根据病程中的最高脓毒性休克评分(septic shock scores,SSS)分为难治组和非难治组,比较两组患儿围生期情况、诊断脓毒性休克时的实验室检查结果及血流动力学参数,并进行多因素logistic回归分析得出独立危险因素,并对独立危险因素进行受试者工作特征曲线分析,得出截断值作为脓毒性休克发生不良预后的早期预测指标。结果共纳入130例患儿,难治组54例,非难治组76例。与非难治组相比,难治组患儿诊断脓毒性休克时的pH、BE值、每搏指数、心输出量、心脏指数明显降低(P<0.05),平均动脉压与心脏指数比值(mean arterial pressure to cardiac index ratio,MAP/CI)[(12.7±5.2)比(8.8±2.9)]、SSS[床边式SSS:1(0,3)分比0(0,0)分;计算式SSS:4.4(1.3,19.2)分比1.3(1.2,1.4)分;改良版计算式SSS:16.7(3.4,20.6)分比2.6(1.8,4.0)分]明显升高(P<0.05)。多因素logistic回归分析显示,MAP/CI高是新生儿难治性脓毒性休克的独立危险因素,曲线下面积0.734,最佳截断值为11.6,敏感度62%,特异度87%,阳性预测值79%,阴性预测值77%;改良版计算式SSS高是新生儿脓毒性休克死亡的独立危险因素,曲线下面积0.845,最佳截断值为5.8,敏感度83%,特异度72%,阳性预测值21%,阴性预测值97%。结论MAP/CI升高(≥11.6)、改良版计算式SSS升高(≥5.8)可分别作为新生儿难治性脓毒性休克诊断及预测死亡的早期指标。Objective To study the early predictors of refractory septic shock(RSS)in neonates.Methods From July 2020 to December 2021,clinical data of neonates with septic shock admitted to the Neonatal Department of our hospital were retrospectively reviewed.According to the maximum septic shock score(SSS)during clinical course,the neonates were assigned into RSS group and non-RSS group.Perinatal data,laboratory results and hemodynamic parameters at diagnosis were compared between the two groups.Multiple logistic regression analysis was used to identify independent risk factors of RSS and septic shock-related death.Receiver operating characteristic(ROC)curve was constructed to evaluate the early predictors of poor prognosis.Results A total of 130 neonates were enrolled,including 54 in RSS group and 76 in non-RSS group.Compared with the non-RSS group,the RSS group had significantly lower pH,base excess(BE),stroke volume index(SVI),cardiac output(CO)and cardiac index(CI).Meanwhile,the RSS group had significantly higher mean arterial pressure(MAP)to CI ratio(MAP/CI)and SSS[including bedside SSS(bSSS),computed SSS(cSSS)and modified version of cSSS(mcSSS)](all P<0.05).Multiple logistic regression analysis showed that increased MAP/CI was an independent predictor of RSS.The cut-off value of MAP/CI was 11.6[sensitivity 62%,specificity 87%,positive predictive value(PPV)79%and negative predictive value(NPV)77%],with an area under the curve(AUC)of 0.734.Increased mcSSS was an independent predictor of septic shock-related death.The cut-off value of mcSSS was 5.8(sensitivity 83%,specificity 72%,PPV 21%and NPV 97%),with an AUC of 0.845.Conclusions Increased MAP/CI(≥11.6)and mcSSS(≥5.8)may be early predictors of RSS and septic shock-related death in neonates.

关 键 词：脓毒性休克 难治性休克 平均动脉压与心脏指数比值 脓毒性休克评分 新生儿 

分 类 号：R722.1[医药卫生—儿科]