摘要
目的:探讨动态血磷水平与老年脓毒症患者病情严重程度的关系以及对预后的预测价值。方法:采用回顾性分析,根据纳入及排除标准选择2014年9月—2018年6月南京医科大学附属老年医院重症医学科(ICU)收治的老年(年龄≥60岁)脓毒症患者,收集患者的一般资料,监测入ICU第1、3、7天的血清磷水平。根据脓毒症严重程度分为脓毒症组、严重脓毒症组及脓毒症休克组,评估不同病情严重程度的3组间动态血磷水平的差异。根据28 d预后将患者分为存活组和死亡组,评估不同预后的两组患者动态血磷水平的差异。以APACHEⅡ评分和第1、3、7天的血清磷水平绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)评估其对老年脓毒症28 d预后的预测价值。结果:本研究共入组104例老年脓毒症患者,比较不同病情严重程度的3组间动态血磷水平,入ICU第1天血磷水平差异无统计学意义(P>0.05),第3、7天血磷水平在脓毒症休克组明显低于脓毒症组与严重脓毒症组(P<0.05)。存活组与死亡组入ICU第1、3天血磷水平差异无统计学意义(P>0.05),而死亡组第7天血磷水平明显低于存活组(P<0.05)。ROC曲线显示APACHEⅡ评分(AUC=0.679)和入ICU第7天血磷水平(AUC=0.641)对老年脓毒症患者预后预测价值高于入ICU第1天血磷水平(AUC=0.601)及入ICU第3天血磷水平(AUC=0.616)。结论:动态血磷水平对老年脓毒症患者病情严重程度及预后的评估具有一定意义,入ICU第7天血磷水平对老年脓毒症患者预后有较好的预测价值,死亡组第7天血磷水平明显低于存活组。
Objective:To investigate the relationship between dynamic blood phosphorus level and the severity of sepsis in elderly patients and assess its prognostic value.Methods:Elderly septic patients admitted to the ICU of the Geriatric Hospital Affiliated to Nanjing Medical University from September,2014 to June,2018,who met the inclusion and exclusion criteria,were involved for a retrospective analysis.The general data and the serum phosphorus levels of the patients were collected on the 1 st,3 rd and 7 th days of ICU entry.According to the severity of sepsis,the patients were divided into sepsis group,severe sepsis group and septic shock group.The differences of dynamic blood phosphorus levels among the three groups were evaluated.According to the 28-day prognosis,the patients were divided into survival group and death group,and the difference of dynamic blood phosphorus levels between the two groups was evaluated.The receiver operating characteristic curve(ROC)of APACHEⅡscore and serum phosphorus levels on the 1 st,3 rd and 7 th days of ICU entry was used to evaluate the prediction for 28-day prognosis.Results:A total of 104 elderly patients with sepsis were involved in this study.No significant difference in blood phosphorus levels on the 1 st day of ICU entry was found among the three groups with different severity of the disease(P>0.05).However,the blood phosphorus levels on the 3 rd and 7 th days in the septic shock group were significantly lower than those in the sepsis and severe sepsis groups(P<0.05).There was no significant difference in the blood phosphorus levels on the 1 st and 3 rd day of ICU entry between the survival group and the death group(P>0.05),and the blood phosphorus level on the 7 th day in the death group was significantly lower than that in the survival group(P<0.05).ROC curve showed that APACHEⅡscore(AUC=0.679)and blood phosphorus level(AUC=0.641)on the 7 th day of ICU entry had higher predictive value for the prognosis of elderly septic patients than the blood phosphorus levels on the 1 st day of ICU entry(AUC=0.601)and the 3 rd day of ICU entry(AUC=0.616).Conclusion:Dynamic blood phosphorus level is of some significance in indicating the severity and prognosis of sepsis in elderly patients.The blood phosphorus level on the 7 th day of ICU entry has better predictive value in the prognosis of sepsis in elderly patients,which is significantly lower in the death group than in the survival group.
作者
佘丽萍
徐剑
邓晓静
卞叶萍
程惠
SHE Liping;XU Jian;DENG Xiaojing;BIAN Yeping;CHENG Hui(Intensive Care Unit,Geriatric Hospital of Nanjing Medical University,Nanjing 210024,China)
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2020年第10期1515-1519,共5页
Journal of Nanjing Medical University(Natural Sciences)
