感染性休克合并急性肺损伤患者的液体治疗与预后的关系

目的探讨感染性休克患者发生急性肺损伤时,首个7 d液体治疗与预后的关系。方法选取感染性休克并发急性肺损伤患者102例为研究对象,根据28 d生存情况分为生存组与死亡组。回顾性分析两组患者首个7 d液体治疗情况,采用ROC曲线分析7 d累积液体平衡量预测死亡率的价值。以7 d累积液体平衡量最优截断值行亚组分析,比较其28 d死亡率。结果生存组患者的7 d累积液体平衡量明显低于死亡组(t=-5.64,P<0.05)。7 d累积液体平衡量=6.34 L为截断值时,预测28 d死亡率的灵敏度和特异度分别为71.10%和71.60%,ROC曲线下面积(AUC)为0.77(P<0.05)。以7 d累积液体平衡量=6.34 L为截点分组,>6.34 L为高平衡组,<6.34 L为低平衡组。液体高平衡组的28 d死亡率62.70%明显高于低平衡组21.30%,差异有统计学意义(χ^2=18.76,P<0.05)。结论累积液体平衡水平与感染性休克并发急性肺损伤患者结局明显相关,当7 d累积液体平衡量>6.34 L时感染性休克并发急性肺损伤患者有着更高的死亡风险。

The relationship between fluid therapy and prognosis in patients with septic shock combined with acute lung injury

Objective To explore the relationship between the first 7-day fluid therapy and prognosis when acute lung injury occurs in patients with septic shock.Methods A total of 102 patients with septic shock combined with acute lung injury were selected as the research objects,and they were divided into survival group and death group according to their 28-day survival status.The first 7-day fluid treatment of the two groups was retrospectively analyzed,and the value of 7-day cumulative equilibrium fluid for predicting mortality was analyzed by ROC curve.The optimal cut-off value of the 7-day cumulative equilibrium fluid was used for subgroup analysis to compare the 28-day mortality.Results The 7-day cumulative fluid balance of the survival group was significantly lower than that of the death group(t=-5.64,P<0.05).When the cut-off value of the 7-day cumulative balance fluid was 6.34L,the sensitivity and specificity of predicting 28-day mortality were 71.10%and 71.60%,respectively,and the area under the ROC curve(AUC)was 0.77(P<0.05).The patients whose 7-day cumulative balance liquid volume larger than 6.34L were enrolled the high balance group,while the patients whose 7-day cumulative balance liquid volume smaller than 6.34L were enrolled the low balance group.The 28-day mortality rate of 62.70%in the high fluid balance group was significantly higher than 21.30%in the low balance group,and the difference was statistically significant(χ^2=18.76,P<0.05).Conclusion Cumulative fluid balance is significantly correlated with the outcome of patients with septic shock combined with acute lung injury,When the 7-day cumulative fluid balance is greater than 6.34L,patients with septic shock and acute lung injury have a higher risk of death.