血乳酸辅助APACHEⅡ判断ICU老年重症感染患者预后的临床意义

doi:10.3969/j.issn.1004-583X.2021.07.005

摘要/Abstract

摘要：

目的研究血乳酸(LAC)辅助急性生理与慢性健康评分Ⅱ(APACHEⅡ)判断重症监护病房(ICU)老年重症感染患者预后的临床意义。方法回顾性分析我院2017年7月-2018年7月ICU病房收治的100例老年重症感染患者,依据患者预后情况分为预后良好(存活,n=82)与预后不良组(死亡,n=18)。收集两组治疗前基础资料信息,包括性别、年龄、感染部位、饮酒史、吸烟史、APACHEⅡ评分及LAC水平,再经过多因素Logistic回归分析,明确影响ICU老年重症感染患者预后的危险因素。结果预后不良组年龄、APACHEⅡ评分及LAC水平显著高于预后良好组(P<0.05)。经ROC分析证实,年龄、APACHEⅡ评分及LAC水平均能用于ICU老年重症感染患者预后的预测,曲线下面积分别为0.878、0.886、0.884(均P<0.05)。经多因素Logistic回归分析证实,年龄≥73岁、APACHEⅡ评分≥13分、LAC≥9.145 mmol/L为ICU老年重症感染患者预后不良的危险因素(均P<0.05)。结论 ICU老年重症感染患者预后受到年龄、APACHEⅡ评分、LAC的影响,临床医师应对其予以密切的关注,对患者的预后评估具有重要意义。

关键词: 重症监护病房, 感染, 乳酸, 预后, 老年人

Abstract:

Objective To study the clinical significance of blood lactate acid(LAC) assisted Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) in judging the prognosis of elderly severe infections (SI) patients in intensive care unit(ICU).Methods The clinical data of 100 elderly SI patients admitted to the ICU ward of our hospital from July 2017 to July 2018 were retrospectively analyzed, and the patients were divided into good prognosis (survival, n=82) and poor prognosis group (death, n=18) according to their prognosis. The general information at admission including gender, age, site of infection, history of alcohol consumption, smoking history, APACHE-Ⅱ score and LAC level were collected in two groups. Multivariate logistic regression analysis was used to predict the risk factors affecting prognosis of elderly SI patients in ICU.Results The age, APACHEⅡ score and LAC level were significantly higher in poor prognosis group than in good prognosis group (P<0.05). ROC analysis confirmed that age, APACHEⅡ score and LAC level could all be used to predict the prognosis of elderly SI patients in ICU. The areas below the curve were 0.878, 0.886 and 0.884, respectively (all P<0.05). Multivariate logistic regression analysis showed that risk factors affecting prognosis of elderly SI patients in ICU were age ≥73 years, APACHEⅡ score ≥13 points, and LAC≥9.145 mmol/L (all P<0.05).Conclusion The prognosis of elderly SI patients in ICU is affected by age, APACHEⅡ score, and LAC. Clinicians should pay close attention to them, which is of great significance to the prognosis evaluation of patients.

Key words: intensive care units, infected, lactic acid, prognosis, aged

中图分类号:

R459.7

张圆, 黄涛, 王保平. 血乳酸辅助APACHEⅡ判断ICU老年重症感染患者预后的临床意义[J]. 临床荟萃, 2021, 36(7): 604-607.

Zhang Yuan, Huang Tao, Wang Baoping. Clinical significance of blood lactic acid assisted APACHEⅡ in judging prognosis of elderly SI patients in ICU[J]. Clinical Focus, 2021, 36(7): 604-607.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.07.005

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I7/604

图/表 4

参考文献 15

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项目	预后不良组 (n=18)	预后良好组 (n=82)	t/χ²值	P值
性别[例(%)]
男女	10(55.56) 8(44.44)	41(50.00) 41(50.00)	0.182	0.669
年龄(岁)	75.23±4.26	72.16±3.21	3.453	0.001
感染部位[例(%)]
肺部	7(38.89)	35(42.68)
腹部	7(38.89)	19(23.17)	2.476	0.480
泌尿道	2(11.11)	19(23.17)
其他	2(11.11)	9(10.78)
吸烟史[例(%)]
有无	10(55.56) 8(44.44)	38(46.34) 44(53.66)	0.502	0.479
饮酒史[例(%)]
有无	12(66.67) 6(33.33)	62(75.61) 20(24.39)	0.614	0.433
APACHEⅡ评分(分)	15.24±6.39	10.24±3.46	4.662	0.000
LAC(mmol/L)	12.48±3.19	7.21±2.19	8.459	0.000

项目	预后不良组 (n=18)	预后良好组 (n=82)	t/χ²值	P值
性别[例(%)]
男女	10(55.56) 8(44.44)	41(50.00) 41(50.00)	0.182	0.669
年龄(岁)	75.23±4.26	72.16±3.21	3.453	0.001
感染部位[例(%)]
肺部	7(38.89)	35(42.68)
腹部	7(38.89)	19(23.17)	2.476	0.480
泌尿道	2(11.11)	19(23.17)
其他	2(11.11)	9(10.78)
吸烟史[例(%)]
有无	10(55.56) 8(44.44)	38(46.34) 44(53.66)	0.502	0.479
饮酒史[例(%)]
有无	12(66.67) 6(33.33)	62(75.61) 20(24.39)	0.614	0.433
APACHEⅡ评分(分)	15.24±6.39	10.24±3.46	4.662	0.000
LAC(mmol/L)	12.48±3.19	7.21±2.19	8.459	0.000

指标	曲线下面积	标准误	P值	95%CI		最佳截断值	敏感度	特异度
指标	曲线下面积	标准误	P值	下限	上限	最佳截断值	敏感度	特异度
年龄	0.878	0.047	0.000	0.786	0.970	73.700	0.778	0.829
APACHEⅡ 评分	0.886	0.050	0.000	0.788	0.984	13.460	0.722	0.988
LAC	0.884	0.063	0.000	0.749	1.000	9.145	0.833	0.988

指标	曲线下面积	标准误	P值	95%CI		最佳截断值	敏感度	特异度
指标	曲线下面积	标准误	P值	下限	上限	最佳截断值	敏感度	特异度
年龄	0.878	0.047	0.000	0.786	0.970	73.700	0.778	0.829
APACHEⅡ 评分	0.886	0.050	0.000	0.788	0.984	13.460	0.722	0.988
LAC	0.884	0.063	0.000	0.749	1.000	9.145	0.833	0.988

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
年龄≥73岁	0.409	0.149	7.571	0.006	1.506	1.125	2.016
APACHEⅡ评分 ≥13分	0.375	0.172	4.764	0.029	1.455	1.039	2.038
LAC≥9.145 mmol/L	1.277	0.432	8.753	0.003	3.587	1.539	8.360