血清白蛋白校正阴离子间隙在重症IABP患者预后评估中的价值  

Predictive value of serum albumin corrected anion gap on the prognosis of severe patients with intra-aortic balloon pump in the ICU

作　　者：丁岚 周庆 陆建红 姬晓伟 DING Lan;ZHOU Qing;LU Jianhong;JI Xiaowei(Department of Intensive Care Unit,Huzhou Central Hospital(Huzhou Hospital Affiliated to School of Medicine,Zhejiang University),Huzhou 313000,China)

机构地区：[1]湖州市中心医院(浙江大学医学院附属湖州医院)重症医学科,313000

出　　处：《心电与循环》2025年第1期51-55,共5页Journal of Electrocardiology and Circulation

基　　金：浙江省基础公益研究计划项目(LGD20H150001)。

摘　　要：目的探讨血清白蛋白校正的阴离子间隙(ACAG)在重症主动脉内球囊反搏(IABP)患者预后评估中的价值。方法收集2008至2019年美国重症监护医学信息数据库2.0中接受IABP治疗的386例重症患者临床资料。根据入院后90 d预后情况分为存活组276例和死亡组110例,比较两组患者临床资料。根据入住重症监护室(ICU)时血清ACAG水平分为高ACAG(>20 mmol/L)组135例和正常ACAG(12~20 mmol/L)组251例,比较两组患者90 d累积生存率。采用Cox比例风险回归模型分析重症IABP患者入院后90 d生存的影响因素。结果与死亡组比较,存活组患者年龄较小,序贯器官衰竭评估评分、阴离子间隙、ACAG、白细胞计数、凝血酶原时间、血肌酐、血钾、血磷、去甲肾上腺素使用率以及合并糖尿病、慢性肾脏病、心脏骤停、心源性休克比例均较低,ICU入住时间较短,而白蛋白、血红蛋白以及合并高血压比例均较高,差异均有统计学意义(均P<0.05)。高ACAG组90 d累积生存率明显低于正常ACAG组(51.85%比82.07%,P<0.001)。ACAG>20 mmol/L(HR=1.595)、高龄(HR=1.046)、使用去甲肾上腺素(HR=2.233)、合并心源性休克(HR=2.300)均是重症IABP患者入院后90 d生存的独立危险因素(均P<0.05)。结论入住ICU时血清ACAG水平升高是重症IABP患者入院后90 d生存的独立危险因素,可为其预后评估提供参考。Objective To investigate the predictive value of albumin-corrected anion gap(ACAG)on the prognosis of severe patients with intra-aortic balloon pump(IABP).Methods A retrospective analysis was performed on 386 adult severe patients received IABP in the intensive care unit(ICU)during 2008 to 2019 who were collected from the US Intensive Care Database.According to the 90-day prognosis,the patients were divided into a survival group(n=276)and a death group(n=110).The differences in the clinical data of the two groups of patients were compared.According to the previous literature,the patients were divided into high ACAG group(serum ACAG at admission to ICU>20 mmol/L,n=135)and normal ACAG group(serum ACAG at admission to ICU 12-20 mmol/L,n=251),and the 90-day cumulative survival rate of the two groups of patients were compared.The Cox proportional hazards model was used to analyze risk factors influencing 90-day survival of severe patients received IABP.Results Compared with the death group,it was found that patients in the survival group were younger,and had lower Sequential Organ Failure Assessment Score,anion gap,ACAG,white blood cell count,prothrombin time,creatinine,serum potassium,serum phosphorus,proportion of norepinephrine usage,and proportions of combined diabetes,chronic kidney disease,cardiac arrest and cardiogenic shock,and had shorter ICU stay while albumin and hemoglobin,and protein of combined hypertension were higher(all P<0.05).Compared with the normal ACAG group,the 90-day cumulative survival rate of the high ACAG group was lower,and the difference was statistically significant(51.85%vs.82.07%,P<0.001).High ACAG>20 mmol/L(HR=1.595),older age(HR=1.046),usage of norepinephrine(HR=2.233),and combining cardiogenic shock(HR=2.300)were independent risk factors for poor prognosis at 90 days of severe patients with IABP(all P<0.05).Conclusion The increase of ACAG level at the time of admission to ICU is an independent risk factor for poor 90-day prognosis of severe patients received IABP.

关 键 词：白蛋白校正阴离子隙 主动脉内球囊反搏 预后 重症监护室 

分 类 号：R47[医药卫生—护理学]