24h乳酸清除率和序贯器官衰竭评分及简化急性生理评分Ⅱ对脓毒症预后的预测价值研究  

Predictive value of 24 h lactate clearance and sequential organ failure score and simplified acute physiological scoreⅡin sepsis

作　　者：徐大千[1] 黄智 冯敏[1] 杨宏富[1] XU Da-qian;HUANG Zhi;FENG Min;YANG Hong-fu(Department of Critical Care Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院重症医学科,郑州450052

出　　处：《医药论坛杂志》2024年第18期1943-1947,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190213)。

摘　　要：目的探究简化急性生理评分Ⅱ(simplified acute physiological score-Ⅱ,SAPSⅡ)、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分及24 h乳酸清除率(24 h lactate clearance,LCR)对脓毒症患者预后的预测价值。方法回顾性研究,选取2023年1月—2024年1月郑州大学第一附属医院外科ICU诊治的96例脓毒症患者,依据预后情况将患者分为生存组71例及死亡组25例。比较两组患者实验室指标[血钙、降钙素原(procalcitonin,PCT)、乳酸脱氢酶(lactate dehydrogenase,LDH)]等水平,24 h LCR、SAPSⅡ评分及SOFA评分,logistic分析24 h LCR、SOFA评分及SAPSⅡ评分对患者预后独立危险因素,ROC曲线评估24 h LCR、SOFA评分及SAPSⅡ评分对患者预后的预测价值。结果生存组血钙指标(2.03±0.21)mmol/L高于死亡组(1.65±0.12)mmol/L,PCT、LDH指标分别是(3.25±0.16)μg/L及(4.93±1.26)mmol/L,均低于死亡组,差异有统计学意义(P<0.05);生存组24 h LCR(30.21±6.73)%高于死亡组(22.16±5.92)%,SAPSⅡ评分及SOFA评分分别是(37.29±7.15)分和(5.86±1.47)分,均低于死亡组,差异有统计学意义(P<0.05);logistic分析数据表明,24 h LCR、SOFA评分及SAPSⅡ评分是患者预后独立危险因素,(P<0.05);ROC曲线分析结果表明:24 h LCR预测患者预后曲线下面积为0.753,灵敏度为74.2%、特异度为73.4%;SOFA评分预测患者预后曲线下面积为0.775,灵敏度为82.9%、特异度为74.8%;SAPSⅡ评分预测患者预后曲线下面积为0.772,灵敏度为85.6%、特异度为72.5%;三者联合预测患者预后曲线下面积为0.802,灵敏度为86.4%、特异度为81.9%。结论SOFA及SAPSⅡ评分、24 h LCR联合血钙、PCT对患者预后有较高预测价值,可作为患者预后的预测指标。Objective To explore the predictive value of simplified acute physiological score-Ⅱ(SAPSⅡ),sequential organ failure assessment(SOFA)score,and 24 h lactate clearance(LCR)on the prognosis of patients with septic shock.Methods A retrospective study was conducted to select 96 patients with sepsis treated in the surgical ICU of the First Affiliated Hospital of Zhengzhou University from January 2023 to January 2024.According to the prognosis,the patients were divided into a survival group(71 cases)and a death group(25 cases).Laboratory indexes[blood calcium,procalcitonin(PCT),lactate dehydrogenase(LDH)]levels,24 h LCR,SAPSⅡscores and SOFA scores were compared between the two groups.The independent risk factors of 24 h LCR,SOFA score and SAPSⅡscore were analyzed by logistic analysis,and the predictive value of 24 h LCR,SOFA score and SAPSⅡscore on patient prognosis was evaluated by ROC curve.Results The blood calcium index(2.03±0.21)mmol/L in survival group was higher than that in death group(1.65±0.12)mmol/L,and the PCT and LDH indexes were(3.25±0.16)μg/L and(4.93±1.26)mmol/L,respectively,which were lower than those in death group(P<0.05).24 h LCR(30.21±6.73)%in survival group was higher than that in death group(22.16±5.92)%,SAPSⅡscore and SOFA score were(37.29±7.15)and(5.86±1.47)points,respectively,which were lower than those in death group(P<0.05).Logistic analysis data showed that 24 h LCR,SOFA score and SAPSⅡscore were independent risk factors for prognosis(P<0.05).ROC curve analysis results showed that 24 h LCR predicted the area under the prognosis curve was 0.753,the sensitivity was 74.2%,and the specificity was 73.4%.SOFA score predicted the area under the prognosis curve was 0.775,sensitivity was 82.9%,specificity was 74.8%.The area under the prognosis curve predicted by SAPSⅡscore was 0.772,the sensitivity was 85.6%,and the specificity was 72.5%.The area under the prognosis curve was 0.802,the sensitivity was 86.4%,and the specificity was 81.9%.Conclusion SOFA and SAPSⅡscores,24-hou

关 键 词：24 h乳酸清除率 序贯器官衰竭评估评分 简化急性生理评分Ⅱ 血钙 降钙素原 脓毒性休克 预后 

分 类 号：R459.7[医药卫生—急诊医学]