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作 者:陈丽玲[1] 李红兵 Chen Liling;Li Hongbing(Department of Laboratory,Traditional Chinese Hospital of Sanya City,Sanya 572000,Hainan,China;Department of Emergency,the First People’s Hospital of Guiyang,Guiyang 550002,Guizhou,China)
机构地区:[1]三亚市中医院检验科,海南三亚572000 [2]贵阳市第一人民医院急诊科,贵州贵阳550002
出 处:《贵州医药》2024年第11期1694-1698,共5页Guizhou Medical Journal
基 金:贵州省自然科学基金重点课题(黔科合基础-ZK[2023]重点001);贵州省卫健委科学技术基金(gzwkj2021-001)。
摘 要:目的探讨中性粒细胞/淋巴细胞比值(NLR)在重症肺炎合并脓毒症患者临床动态分析中的应用。方法采用回顾性分析的方法,纳入贵阳市第一人民医院和三亚市中医院2022年12月至2023年3月入住ICU的重症肺炎合并脓毒症患者共计86例,其中死亡64例、好转22例。分析死亡组和好转组患者基线资料及入院时、治疗中、死亡/好转前的血常规、生化、凝血、血气等指标的动态改变;根据患者转归信息绘制患者死亡/好转前的NLR受试者工作曲线(ROC),根据NLR最佳截断值进行生存分析。结果性别、年龄对患者的转归没有显著性影响(P>0.05);死亡患者多在Ⅱ型呼吸衰竭的基础上出现多脏器功能损伤;死亡患者总胆红素(TBIL)、直接胆红素(DBIL)、肌酐(Cr)、尿素氮(BUN)、尿酸(UA)、D-二聚体(D-D)、降钙素原(PCT)、乳酸(LaC)表现为动态性升高,而淋巴细胞绝对值(LY)、pH则表现为动态性降低;患者死亡/好转前NLR预测死亡的最佳截断值分别为:20.15,NLR≤20.15中位生存时间为15 d,NLR>20.15中位生存时间为7 d。结论重症肺炎合并脓毒症患者在Ⅱ型呼吸衰竭的基础上合并多器官功能障碍、凝血障碍等情况下容易导致不良后果;NLR能较好地反应重症肺炎合并脓毒症患者的预后情况,应加强监测。Objective To explore clinical dynamic application of neutrophil/lymphocyte ratio(NLR)in severe pneumonia with sepsis.Methods With retrospective analysis,86 patients who were diagnosed as severe pneumonia with sepsis and admitted in ICU of Traditional Chinese Hospital of Sanya City from December in 2022 to March in 2023 were enrolled,of which 64 died and 22 improved.Analyzed the baseline data,the dynamic changes of blood routine,biochemical,coagulation,blood gas and other indicators between the death group and the improvement group when admitted,during treatment and before death/improvement.Drawn receiver operating curve(ROC)according to NLR when admitted,during treatment and before death/improvement based on patients’outcome,and perform survival analysis based on the best cut-off value of NLR.Results There were no significant effect for gender and age on the outcome of severe pneumonia with sepsis.Most of the death patients developed multiple organs dysfunction on the basis of typeⅡrespiratory failure.Serum levels of total bilirubin(TBIL),direct bilirubin(DBIL),creatinine(Cr),urea nitrogen(BUN),uric acid(UA),D-dimer(D-D),procalcitonin(PCT),and lactic acid(LaC)dynamically were increased,while LY and pH dynamically were decreased in death group.The best cut-off value of NLR before death/improvement were 20.15.The median survival time for NLR≤20.15 was 15 days,while it was 7 days for NLR>20.15.Conclusion Patients that diagnosed as severe pneumonia with sepsis are easy to develop multiple organs dysfunction and coagulopathy on the basis of typeⅡrespiratory failure patients are prone to worsening their condition or even die.NLR can predict the prognosis in severe pneumonia with sepsis reliably and should be dynamically monitored.
关 键 词:重症肺炎 脓毒症 中性粒细胞/淋巴细胞比值 多器官功能障碍 生化分析
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