肾阻力指数和中心静脉压对脓毒性休克患者28d内死亡风险的预测价值  

Value of renal resistance index combined with central venous pressure in predicting 28-day mortality risk in patients with septic shock

作　　者：陈纪豪 林连根 潘克跃 姜盈盈 陈玲珑 CHEN Jihao;LIN Liangen;PAN Keyue;JIANG Yingying;CHEN Linglong(Graduate School,Zhejiang Chinese Medical University,Hangzhou 310053,CHINA)

机构地区：[1]浙江中医药大学研究生院,浙江杭州310053 [2]温州市人民医院急诊科

出　　处：《江苏医药》2025年第3期255-258,263,共5页Jiangsu Medical Journal

基　　金：温州市科技局项目(Y20220491)。

摘　　要：目的探讨肾阻力指数(RRI)和中心静脉压(CVP)对脓毒性休克患者28d内死亡风险的预测价值。方法回顾性分析213例脓毒性休克患者的临床资料。根据脓毒性休克患者28d内是否死亡,分为死亡组(57例)和存活组(156例)。采用多因素logistic回归分析脓毒性休克患者28d内死亡风险的影响因素,并构建ROC曲线验证RRI联合CVP模型的预测价值。结果两组间GCS评分、血培养阳性比例、CVP、RRI、机械通气比例、机械通气时间、血乳酸、序贯器官衰竭评估评分、急性生理学与慢性健康状况评价Ⅱ评分差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,RRI增加、CVP增加、血培养阳性和血乳酸升高是脓毒性休克患者28d内死亡风险的独立危险因素(P<0.05),而GCS评分增加是其保护性因素(P<0.05)。ROC曲线分析结果显示,RRI联合CVP预测脓毒性休克患者28 d内死亡风险的AUC为0.838[95%CI(0.777~0.899),P<0.05]。结论RRI和CVP均与脓毒性休克患者28d内死亡密切相关,两者联合对脓毒性休克患者28d内死亡风险具有较高的预测价值。Objective To investigate the predictive value of renal resistance index(RRI)and central venous pressure(CVP)for the risk of mortality within 28 days in the patients with septic shock.Methods Clinical data of 213 patients with septic shock were retrospectively analyzed,of whom 57 patients were died within 28 days(death group)and 156 patients were survival within 28 days(survival group).The multivariate logistic regression was used to identify the factors influencing 28-day mortality risk in the patients with septic shock.ROC curve was constructed to assess the predictive value of combined use of RRI and CVP.Results There were significant differences between the two groups in Glasgow Coma Scale(GCS)score,the proportion of positive blood cultures,CVP,RRI,the proportion of the patients requiring mechanical ventilation,duration of mechanical ventilation,serum lactate level,Sequential Organ Failure Assessment score and Acute Physiology and Chronic Health EvaluationⅡscore(P<0.05).Multivariate logistic regression analysis showed that increased RRI,increased CVP,positive blood cultures and increased serum lactate level were the independent risk factors to influence the 28-day mortality risk of the patients with septic shock(P<0.05),while increased GCS score was the independent protective factor(P<0.05).The ROC curve indicated that the AUC for predicting 28-day mortality risk in septic shock patients using the combined RRI and CVP was 0.838[95%CI(0.777-0.899),P<0.05].Conclusion The RRI and CVP are closely associated with 28-day mortality in the patients with septic shock.Combined use of the two factors offers a high predictive value for the risk of mortality within 28 days in the patients with septic shock.

关 键 词：脓毒性休克 肾阻力指数 中心静脉压 

分 类 号：R631[医药卫生—外科学]