摘要
目的 探讨急性生理学和慢性健康状况评估Ⅱ(APACHEⅡ)评分联合CVP对脓毒性休克患者院内死亡的预测价值。方法 根据28-d院内死亡,将307例脓毒性休克患者分为死亡组(106例)和非死亡组(201例)。比较两组临床资料和实验室相关指标,采用多因素logistic回归分析脓毒性休克患者院内死亡的危险因素,绘制ROC曲线分析APACHEⅡ评分和CVP单独及联合检测对脓毒性休克患者院内死亡的预测效能。结果 与非死亡组比较,死亡组患者年龄大,需要连续肾脏替代治疗和机械通气的比例高,机械通气时间长,肺部疾病比例高,序贯器官衰竭估计(SOFA)评分和APACHEⅡ评分高(P<0.05或P<0.01)。与非死亡组比较,死亡组CVP、pH、乳酸、国际标准化比值、ALT和AST高,凝血酶原时间和活化部分凝血活酶时间长,而白蛋白低(P<0.05或P<0.01)。需要机械通气和高CVP、SOFA评分及APACHEⅡ评分是脓毒性休克患者院内死亡的独立危险因素(P<0.05或P<0.01)。APACHEⅡ评分和CVP联合预测脓毒性休克患者院内死亡的AUC为0.836,灵敏度和特异度分别为77.4%和75.1%。结论 高APACHEⅡ评分和高CVP是脓毒性休克患者院内死亡的独立危险因素,两者联合检测的预测效能较高。
Objective eTo explore the predictive value of acute physiology and chronic health evaluation II(APACHEII)score combined with CVP in the hospital death of the patients with septic shock.Methods According to 28-day inhospital death,307 patients with septic shock were divided into death group((106 cases)and non-death group(201 cases).The clinical data and relevant laboratory indicators of the two groups were compared.The risk factors for inhospital death of the patients with septic shock were analyzed by multivariate logistic regression.The ROC curve was drawn to analyze the predictive efficacy of APACHE II score and CVP alone and in combination in predicting inhospital death of the patients with septic shock.Results Compared with non-death group,death group had older age,higher proportions of needing continuous renal replacement therapy,mechanical ventilation,longer duration of mechanical ventilation,higher proportion of lung disease,and higher scores of sequential organ failure assessment(SOFA)(P<0.05 or P<0.01).Compared with non-death group,death group had higher CVP,pH,lactic acid,international normalized ratio,ALT and AST,longer prothrombin time and activated partial thromboplastin time,and lower albumin(P<0.05 or P<0.01).The need for mechanical ventilation and higher CVP,SOFA and APACHE II scores were the independent risk factors for inhospital death of the patients with septic shock(P<0.O5) or P<0.01).The AUC of combined use of APACHEII score and CVP in predicting inhospital death in the patients with septic shock was 0.836,and sensitivity and specificity were 77.4%and 75.1%,respectively.Conclusion Higher APACHE II score and CVP are the independent risk factors for inhospital death of the patients with septic shock.Combined use of APACHE II score and CVP has higher predictive value.
作者
潘克跃
张程浩
张彪
陈玲珑
PAN Keyue;ZHANG Chenghao;ZHANG Biao;CHEN Linglong(Department of Emergency,Wenzhou People's Hospital,Wenzhou 325000,CHINA)
出处
《江苏医药》
CAS
2024年第9期891-895,共5页
Jiangsu Medical Journal
基金
温州市科技局项目(Y20220501)。
作者简介
通信作者:陈玲珑,E-mail:77587332@qq.com。
