摘要
目的探讨血钙联合血清6 h乳酸清除率(6 h LCR)对脓毒症患者病情及预后的评估价值。方法选取重症医学科(ICU)收治的脓毒症患者120例为研究对象,根据出院后28 d的电话随访情况分为死亡组(n=24)和存活组(n=96),收集2组脓毒症患者的一般资料(性别、年龄、感染部位、合并基础疾病、吸烟饮酒史、是否发生感染性休克等)和入住ICU的资料[6 h LCR、血清降钙素原(PCT)、乳酸(Lac)、C-反应蛋白(CRP)、序贯器官衰竭评分(SOFA)、24 h内急性生理学与慢性健康状况评分(APACHEⅡ)及2组脓毒症患者入住ICU时的桡动脉血钙水平];采用非条件logistic回归法分析脓毒症患者出院28 d内死亡的危险因素,采用受试者工作特征曲线(ROC)分析血钙、LCR及2项指标联合应用对脓毒症患者预后的判定价值。结果与生存组比较,死亡组脓毒症患者的年龄、感染性休克比例、Lac、APACHEⅡ评分、SOFA评分及PCT水平升高(P<0.05),6 h LCR、血钙降低(P<0.05);非条件logistic回归法分析显示,APACHEⅡ评分、SOFA评分、Lac、6 h LCR、PCT及血钙是脓毒症患者28 d死亡的独立危险因素(P<0.05);LCR+血钙的ROC曲线下面积(AUC)为0.932,敏感度为83.33%,特异度为94.79%。结论血钙联合6 h LCR可有效评估脓毒症患者的病情进展及预后。
Objective To explore evaluation value of blood calcium combined with 6 hour serum lactate clearance rate(6 h LCR)in disease condition and prognosis of septic patients.Methods A total of 120 patients with sepsis admitted to intensive care unit(ICU)were selected as the research objects.According to the prognosis of all septic patients within 28 days after discharge was followed by telephone,the patients were divided into death(n=24)and survival(n=96)groups.Baseline data(gender,age,infection site,underlying diseases,smoking and drinking history,whether septic shock occurred,etc)was collected.Clinical variables of these patients admitted to the ICU were examined,including 6 h LCR,serum procalcitonin(PCT),lactate(Lac),C-reactive protein(CRP),sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score within 24 hour,and calcium level of radial artery blood.Unconditional logistic regression was used to analyze the risk factors of death within 28 days of hospital discharge.Receiver operating characteristic(ROC)curve was used to analyze the prognostic values of blood calcium,LCR or the combination of blood calcium with LCR for septic patients.Results When compared to the survival group,age,the proportion of septic shock,Lac,APACHEⅡscore,SOFA score and PCT level were increased in the death group(P<0.05),while 6 h LCR and blood calcium were decreased(P<0.05).Unconditional logistic regression analysis showed that APACHEⅡscore,SOFA score,Lac,6 h LCR,PCT and blood calcium were independent risk factors for 28-day mortality in septic patients(P<0.05).The area under ROC curve(AUC)of the combination of LCR and blood calcium was 0.932,and the sensitivity and the specificity were 83.33%and 94.79%,respectively.Conclusion Blood calcium combined with 6 h LCR can effectively reflect the disease progression and prognosis of the patients with sepsis.
作者
王倅旭
闵瑞雪
李秀玲
方齐
张霞
WANG Cuixu;MIN Ruixue;LI Xiuling;FANG Qi;ZHANG Xia(Department of Intensive Care Unit,Rushan People's Hospital,Weihai 264500,Shandong,China;Department of Rehabilitation,Rushan People's Hospital,Weihai 264500,Shandong,China;Department of Clinical Laboratory,Rushan People's Hospital,Weihai 264500,Shandong,China;Department of Neurology,Rushan People's Hospital,Weihai 264500,Shandong,China)
出处
《贵州医科大学学报》
CAS
2022年第7期858-862,868,共6页
Journal of Guizhou Medical University
基金
山东省医药卫生科技发展计划项目(2019WS218)。
关键词
脓毒症
预后
血钙
乳酸清除率
脓毒性休克
病情评估
sepsis
prognosis
blood calcium
lactate clearance rate
septic shock
disease severity assessment
