[1]肖武强,董 磊,吴先正△.急性胃肠损伤分级联合D-乳酸、内毒素水平测定对脓毒症患者预后的评估价值*[J].陕西医学杂志,2020,49(12):1577-1579,1583.[doi:DOI:10.3969/j.issn.1000-7377.2020.12.010]
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急性胃肠损伤分级联合D-乳酸、内毒素水平测定对脓毒症患者预后的评估价值*
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
49
期数:
2020年12期
页码:
1577-1579,1583
栏目:
临床研究
出版日期:
2020-12-05

文章信息/Info

作者:
肖武强董 磊吴先正
同济大学附属同济医院急诊医学科(上海 200065)
关键词:
脓毒症 急性胃肠损伤 D-乳酸 内毒素 预后
分类号:
R631
DOI:
DOI:10.3969/j.issn.1000-7377.2020.12.010
文献标志码:
A
摘要:
目的:探讨急性胃肠损伤(AGI)分级联合D-乳酸、内毒素水平测定对脓毒症患者预后的评估价值。方法:选取脓毒症患者84例,根据28 d内死亡情况分为存活组(51例)和死亡组(33例)。比较两组患者D-乳酸、内毒素、AGI分级及其他临床特征,并进行急性生理学及慢性健康状况(APACHE Ⅱ)评分、序贯器官衰竭(SOFA)评分。采用Logistic回归分析影响脓毒症患者28 d内预后的危险因素。采用ROC曲线分析指标对脓毒症患者预后的预测价值。结果:与AGI Ⅰ-Ⅱ级比较,AGI Ⅲ-Ⅳ级患者APACHE Ⅱ评分、SOFA评分、内毒素及病死率显著升高; 与AGI Ⅲ级比较,AGI Ⅳ级APACHE Ⅱ评分、SOFA评分、内毒素亦显著升高(P<0.05)。随着AGI分级升高,D-乳酸水平显著升高(P<0.05)。与死亡组比较,存活组年龄较小,24 h尿量显著增加,CRP、APACHE Ⅱ评分、SOFA评分、AGI评分、机械通气(MV)比例、D-乳酸、内毒素显著降低(P<0.05)。多因素Logistic回归分析显示,APACHE Ⅱ评分、AGI分级、D-乳酸、内毒素均是脓毒症患者28 d内死亡的独立危险因素(P<0.05)。AGI分级、D-乳酸、内毒素联合预测脓毒症患者死亡的曲线下面积(AUC)为0.937(95%CI:0.872~0.978),灵敏度为93.1%,特异度为96.7%,均显著高于AGI分级、内毒素、D-乳酸的单独预测结果(P<0.05)。结论:AGI分级有助于区分胃肠功能障碍严重程度,联合D-乳酸、内毒素水平测定可有效预测脓毒症患者预后。

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备注/Memo

备注/Memo:
*上海市卫生计生系统重要薄弱学科建设计划项目(2016ZB0204)
更新日期/Last Update: 2020-12-11