改良休克指数对脓毒症休克病人预后风险的预测价值

陈刚; 汪文婧; 程储记

doi:10.13898/j.cnki.issn.1000-2200.2023.04.019

改良休克指数对脓毒症休克病人预后风险的预测价值

Predictive value of modified shock index on prognostic risk in septic shock patients

摘要

摘要:
目的探讨改良休克指数(MSI)与脓毒症休克病人心功能障碍和预后的相关性。
方法选取脓毒症休克病人139例, 收集入院时一般临床资料、实验室检测指标、急性生理与慢性健康评分(APACHE-Ⅱ)、心功能指标, 计算入院时休克指数(SI)、平均动脉压(MAP)和MSI, 根据其1个月预后情况分为生存组及死亡组。应用Pearson相关模型分析MSI与脓毒症休克病人心功能的相关性, 并采用logistic多因素回归分析影响脓毒血症休克预后的危险因素, 使用ROC曲线分析MSI对脓毒症休克病人预后风险的预测价值。
结果生存组病人收缩压、舒张压均高于死亡组, 而心率、APACHE-Ⅱ评分均低于死亡组(P < 0.01)。生存组病人MAP、心指数(CI)、左心室射血分数(LVEF)均高于死亡组(P < 0.01), N端脑钠肽前体(NT-proBNP)、左心室舒张末期容积(LVEDV)、SI、MSI均低于死亡组(P < 0.01)。MSI与脓毒症休克病人的NT-proBNP、LVEDV水平呈正相关(r=0.601、0.598, P < 0.01), 与CI和LVEF呈负相关(r=-0.683、-0.659, P < 0.01)。APACHE-Ⅱ、SI、MSI、和LVEF升高均是脓毒症休克病人死亡的危险因素(OR=1.668、55.070、9.077×10⁵、1.259, P < 0.05~P < 0.01);MAP、CI和LVEDV升高均是脓毒症休克病人死亡的保护因素(OR=0.861、0.191、0.941, P < 0.05~P < 0.01)。
结论对于脓毒症休克病人而言, MSI越高病人心功能越差; 同时MSI是病人死亡的独立危险因素。入院时可将MSI作为心功能障碍及预后的预测因子。

Abstract:
ObjectiveTo investigate the predictive value of modified shock index (MSI) on cardiac dysfunction and prognostic risk in septic shock patients.
MethodsA total of 139 patients with septic shock were selected, the general clinical data, laboratory testing indicators, APACHE-Ⅱ score and cardiac function indicators were collected at admission, shock index (SI), mean arterial pressure (MAP) and MSI were calculated.According to their 1-month prognosis, the patients were divided into survival group and death group.Pearson correlation model was used to analyze the correlation between MSI and cardiac function in septic shock patients, and logistic multivariate regression analysis was used to analyze the risk factors affecting the prognosis of septic shock.
ResultsIn survival group, the systolic blood pressure and diastolic blood pressure were higher, while heart rate and APACHE-Ⅱ score were lower than those in death group (P < 0.01).MAP, cardiac index (CI) and left ventricular ejection fraction (LVEF) were higher than those in death group (P < 0.01), while N-terminal pro brain natriuretic peptide (NT-proBNP), left ventricular end diastolic volume (LVEDV), SI and MSI were lower than those in death group (P < 0.01).MSI was positively correlated with NT-proBNP and LVEDV levels in septic shock patients (r=0.601, 0.598, P < 0.01), and was negatively correlated with CI and LVEF (r=-0.683, -0.659, P < 0.01).The increased APACHE-Ⅱ, SI, MSI and LVEF were all risk factors for mortality of the septic shock patients (OR=1.668, 55.070, 9.077×10⁵, 1.259, P < 0.05 to P < 0.01), while the increases of MAP, CI and LVEDV were the protective factors for mortality of the septic shock patients (OR=0.861, 0.191, 0.941, P < 0.05 to P < 0.01).
ConclusionsFor patients with septic shock, the higher the MSI, the worse the cardiac function.At the same time, MSI is an independent risk factor for mortality of septic shock patients, and MSI can be used as a predictor of cardiac dysfunction and prognosis at admission.

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