重症监护病房老年感染性休克患者的预后危险因素分析

被引：21

作者：

叶龙强

董绉绉

石林惠

王俊聪

徐志伟

机构：

[1] 宁波市医疗中心李惠利东部医院重症医学科

来源：

中华临床感染病杂志 | 2019年 / 12卷 / 03期

关键词：

重症监护病房; 感染性休克; 危险因素; 预后;

D O I：

暂无

中图分类号：

R459.7 [急症、急救处理];

学科分类号：

100231 [临床病理学];

摘要：

目的分析重症监护病房(ICU)老年感染性休克患者预后危险因素, 为临床判断和治疗提供参考。方法回顾性分析2015年11月至2019年3月宁波市医疗中心李惠利东部医院ICU收治的老年感染性休克患者, 共113例, 其中存活组73例, 死亡组40例。分析两组患者的一般情况、基础疾病、实验室指标和侵入性操作, 采用多因素Logistic回归分析感染性休克的预后危险因素, ROC曲线分析危险因素对死亡的预测价值。结果多因素Logistic回归分析显示, 急性生理和慢性健康状况(APACHEII)评分(OR=1.344, 95%CI 1.187～1.520, P<0.01)和入住ICU时乳酸水平(OR=1.311, 95%CI 1.075～1.599, P<0.01)为预后的独立危险因素, 血小板计数(OR=0.986, 95%CI 0.976～0.996, P<0.01)和白蛋白水平(OR=0.812, 95%CI 0.697～0.945, P<0.01)为预后的保护因素。ROC曲线分析显示:APACHEII评分、入住ICU时乳酸水平、APACHEII评分联合入住ICU时乳酸水平的曲线下面积分别为0.861(95%CI 0.784～0.919, P<0.01)、0.752(95%CI 0.662～0.828, P<0.01)、0.904(95%CI 0.834～0.951, P<0.01)。APACHEII评分联合入住ICU时乳酸水平的预测价值优于APACHEII评分、入住ICU时乳酸水平(Z=2.175和2.879, P<0.05和P<0.01)。结论降低APACHEII评分和乳酸水平、增加血小板计数、适当补充白蛋白有助于改善ICU老年感染性休克患者预后。APACHEII评分联合入住ICU时乳酸水平具有较好的死亡预测价值。

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