早期液体复苏入量及相关临床指标对老年脓毒性休克患者预后评估分析  

Analysis of Prognostic Evaluation of Early Fluid Resuscitation Intake and Related Clinical Indicators in Elderly Patients with Septic Shock

作　　者：王雅欣 毕俏杰[2] 

机构地区：[1]青岛大学附属青岛市市立医院,山东 青岛 [2]青岛市市立医院东院急诊科,山东 青岛

出　　处：《临床医学进展》2024年第3期2230-2239,共10页Advances in Clinical Medicine

摘　　要：目的:研究早期液体复苏入量及相关临床指标包括血尿素氮(BUN)、乳酸清除率(LCR)、下腔静脉变异度(IVCV)及急性生理与慢性健康(APACHE II)评分、序贯器官衰竭估计(SOFA)评分对老年脓毒性休克患者预后评估价值。方法:研究纳入2020年10月至2023年10月青岛市市立医院东院区收治的70例老年脓毒性休克患者,根据患者28天预后结果分为存活组(34例,48.6%)和死亡组(36例,51.4%),比较两组患者入院时的一般资料及入院6 h时的液体复苏入量、LCR、IVCV及入院24小时内APACHE II评分、SOFA评分,应用二元Logistic回归分析法分析影响老年脓毒性休克患者28天预后的独立危险因素,并绘制受试者工作特征(ROC)曲线,评估各指标对老年脓毒性休克患者28天预后的评估价值。结果:死亡组的BUN、APACHE II评分、SOFA评分高于存活组,6 h LCR低于存活组,且死亡组入院6 h无下腔静脉变异度(完全机械通气患者IVCV < 18%或自主呼吸患者IVCV < 50%)的患者明显多于存活组(P < 0.05)。死亡组患者在入院6小时内接受了更多的液体入量(P < 0.05)。应用二元Logistic回归分析校正了年龄、性别、BMI、白蛋白、CRP、PCT、基础疾病等混杂因素后,结果显示BUN (OR = 1.087, P < 0.05)、6 h LCR (OR = 0.983, P < 0.05)、6 h IVCV (OR = 15.557, P < 0.01)、APACHE II评分(OR = 1.175, P < 0.01)、SOFA评分(OR = 1.586, P < 0.01)、及入院6 h液体复苏入量(OR = 1.001, P < 0.05)均是影响老年脓毒性休克患者死亡的独立危险因素。绘制ROC曲线分析显示BUN、6 h LCR、APACHE II评分、SOFA评分、6 h液体复苏入量对老年脓毒性休克患者28天预后均有一定预测价值(P < 0.05)。其中APACHE II评分(AUC = 0.737, Cut-off = 26.50, P < 0.01)、SOFA评分(AUC = 0.735, Cut-off = 9.50, P < 0.01)预测老年脓毒性休克患者28天预后的AUC高于其他指标,低于四者联合指标(AUC = 0.785, P < 0.01)。上述六个指标联合对老年脓毒性休克患者28天Objective: Research on early fluid resuscitation volume and associated clinical indicators involves blood urea nitrogen (BUN), lactate clearance rate (LCR), inferior vena cava variability (IVCV), acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score for prognostic assessment in elderly patients with septic shock. Methods: The study included 70 elderly septic shock patients admitted in the East Hospital District of Qingdao Municipal Hospital from October 2020 to October 2023. According to the 28-day prognosis of patients, they were divided into survival group (34 cases, 48.6%) and death group (36 cases, 51.4%), Compare the general information of two groups of patients upon admission, as well as the fluid resuscitation volume, LCR, IVCV at 6 hours of admission, and APACHE II and SOFA scores within 24 hours of admission, the application of binary logistic regression analysis to analyze the independent risk factors affecting the 28-day prognosis of elderly patients with septic shock, and plot the working characteristics of the subjects (ROC) curve to evaluate the evaluation value of each indicator for the 28-day prognosis of elderly patients with septic shock. Results: The BUN, APACHE II and SOFA scores in the death group were higher than those in the survival group, 6 h LCR was lower than in the survival group, and the patients who were admitted to the death group for 6 hours without inferior vena cava variation (IVCV < 18% in patients with complete mechanical ventilation or IVCV < 50% in patients with autonomous breathing) were obvious, more than the surviving group (P < 0.05). The patients in the dead group received more fluid intake (P < 0.05) within 6 hours of admission. After applying binary logistic regression analysis to correct age, gender, BMI, albumin, CRP, PCT, basic diseases and other mixed factors, the results showed BUN (OR = 1.087, P < 0.05), 6 h LCR (OR = 0.983, P < 0.05), 6 h IVCV (OR = 15.557, P < 0.01), APACHE II score (OR = 1.175, P

关 键 词：老年脓毒性休克 早期液体复苏 乳酸清除率 下腔静脉变异度 血尿素氮 

分 类 号：R47[医药卫生—护理学]