复苏前后外周灌注指数、乳酸水平变化对脓毒症休克患者预后评估的价值  

The value of changes in peripheral perfusion index and lactate level before and after resuscitation in the prognosis assessment of patients with septic shock

作　　者：樊一春 刘维维 FAN Yichun;LIU Weiwei(Department of Critical Care Medicine,363 Hospital,Chengdu Sichuan 610000,China)

机构地区：[1]三六三医院重症医学科,四川成都610000 [2]西安市大兴医院重症医学科,陕西西安710013

出　　处：《中国急救复苏与灾害医学杂志》2025年第2期221-224,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：四川省卫生健康委员会医学科技项目(编号:21PJ176)。

摘　　要：目的探究复苏前后外周灌注指数(PI)、乳酸(Lac)水平变化对脓毒症休克患者预后评估的价值。方法回顾性选取2021年1月—2023年6月间三六三医院、西安市大兴医院收治的127例脓毒症休克患者纳入研究,检测患者复苏前后PI和Lac水平变化情况。观察患者28 d预后情况,根据患者生存、死亡情况将其分为预后良好组和预后不良组,并比较两组患者复苏前后PI和Lac水平变化情况。收集患者临床相关资料,并比较不同预后患者临床资料,用多因素COX分析影响患者预后的因素,用受试者工作特征(ROC)曲线分析患者复苏前后PI和Lac水平变化值对其预后的预测价值。结果脓毒症休克患者预后不良发生率为28.35%(36/127)。预后不良组复苏前后PI差值、Lac差值均低于预后良好组(P<0.05)。两组性别、体质量指数(BMI)、合并基础疾病、感染部位、入住ICU时间、液体复苏量比较无统计学差异(P>0.05);预后不良组年龄、有吸烟史占比、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分均高于预后良好组(P<0.05)。COX多因素结果显示,复苏前后PI差值(OR=0.305)、复苏前后Lac差值(OR=0.451)是脓毒症休克患者预后的保护因素,APACHEⅡ评分(OR=6.385)、SOFA评分(OR=5.037)是危险因素(P<0.05)。ROC结果显示,复苏前后PI差值、Lac差值及二者联合预测脓毒症休克患者预后的敏感度分别为75.00%、77.80%、88.90%,特异性分别为73.60%、74.70%、90.10%,曲线下面积(AUC)分别为0.806、0.782、0.938。结论复苏前后PI差值、Lac差值是脓毒症休克患者预后的保护因素。复苏前后PI差值、Lac差值对患者预后均有一定的评估价值,但二者联合对患者预后的评估价值更好。Objective To study the prognostic value of peripheral perfusion index(PI)and lactic acid(Lac)level before and after resuscitation in patients with septic shock.Methods A retrospective analysis was conducted on 127 patients with septic shock who were admitted to our Hospitals from January 2021 to June 2023.The changes of PI and Lac levels before and after resuscitation were detected.The prognosis of patients at 28 days was observed.All patients were divided into good prognosis group and poor prognosis group according to the 28-day mortality.The clinical data of patients;the changes of PI and Lac levels before and after resuscitation were compared between the two groups.Multivariate COX analysis was used to analyze the risk factors of the prognosis of patients.Thereceiver operating characteristic(ROC)curve was used to analyze the predictive value of the changes of PI and Lac levels before and after resuscitation for their prognosis.Results The incidence of poor prognosis in patients with septic shock was 28.35%(36/127).The changes of PI and Lac before and after resuscitation in the poor prognosis group were significantly lower than those in the good prognosis group(P<0.05).There were no significant differences in gender,body mass index(BMI),combined underlying diseases,infection site,ICU stay time,and fluid resuscitation volume between the two groups(P>0.05).The age,smoking history,acute physiology and chronic health evaluationII(APACHE II)score and sequential organ failure assessment(SOFA)score in poor prognosis group were higher than those in good prognosis group(P<0.05).COX multivariate analysis showed that the changes of PI before and after resuscitation(OR=0.305)and Lac(OR=0.451)were protective factors for the prognosis of patients with septic shock,while APACHE II score(OR=6.385)and SOFA score(OR=5.037)were risk factors(P<0.05).PI or/and Lac to predict the prognosis of patients with sepsis shock sensitivity were 75.00%,77.80%,88.90%,specificity of 73.60%,74.70%,90.10%respectively;the Area Under the Curve(AUC)

关 键 词：脓毒症休克 外周灌注指数 乳酸 预后评估 

分 类 号：R459.7[医药卫生—急诊医学]