| 韩建伟.脓毒性休克患者早期血流动力学状态与临床结局的相关性分析[J].内科急危重症杂志,2026,32(5):470-474 |
| 脓毒性休克患者早期血流动力学状态与临床结局的相关性分析 |
| Correlation between early hemodynamic status and clinical outcome in patients with septic shock |
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| DOI：10.11768/nkjwzzzz.202504150508 |
| 中文关键词: 血流动力学 液体平衡 脓毒性休克 |
| 英文关键词: Hemodynamics Fluid balance Septic shock |
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| 中文摘要: |
| 摘要 目的：探讨脓毒性休克患者早期血流动力学状态与治疗第7日累积液体平衡的相关性。方法：采用回顾性队列研究，纳入重症监护病房（ICU）收治的脓毒性休克患者。根据入ICU后首日血流动力学状态，将患者分为改善组与未改善组。比较2组的基线特征、临床指标及预后差异，并进行器官功能障碍亚组分析。结果：817例患者纳入研究，其中改善组319例，未改善组498例。与未改善组相比，改善组患者在第7日累积液体平衡量更低（P=0.024）、序贯器官衰竭评分（SOFA）下降更显著（P<0.001），新发器官功能障碍发生率（P=0.031）及28 d全因病死率（P<0.0001）均显著降低。亚组分析显示，无器官功能障碍患者在第3日及第7日呈现更显著的液体负平衡（P均<0.05）。Kaplan-Meier生存分析显示，血流动力学未改善患者的28 d死亡风险比为2.14（95%CI：1.64~2.89）。多因素回归分析显示，年龄、基线SOFA评分、急性生理学与慢性健康状况评估（APACHE II）评分、急性肾功能不全病史及冠心病史是患者不良预后的独立危险因素；入院后第3日与第7日累积液体平衡亦与不良预后显著独立相关。结论：脓毒性休克患者入ICU后首日血流动力学改善与第3日、第7日液体负平衡、器官功能障碍减少及28 d死亡风险降低显著相关。 |
| 英文摘要: |
| Abstract Objective: To investigate the correlation between early hemodynamic status and cumulative fluid balance on the 7th day of treatment in patients with septic shock. Methods: A retrospective cohort study was conducted to enroll patients with septic shock admitted to the intensive care unit (ICU). According to the hemodynamic status on the first day after admission to ICU, the patients were divided into the improvement group and non-improvement group. The baseline characteristics, clinical indicators and prognosis of the two groups were compared, and the organ dysfunction subgroup analysis was performed. Results: A total of 817 patients were included in the study, with 319 in the improvement group and 498 in the non-improvement group. The improvement group had a lower cumulative fluid balance on day 7 (P= 0.024), a more significant decline in sequential organ failure assessment (SOFA) score (P< 0.001), a lower incidence of new-onset organ dysfunction (P= 0.031), and a lower 28-day all-cause mortality (P< 0.0001) than those in the non-improvement groupt. Subgroup analysis showed that patients without organ dysfunction had more significant negative fluid balance on the day 3 and 7 (all P< 0.05). Kaplan-Meier survival analysis showed that the hazard ratio of 28-day mortality in patients without hemodynamic improvement was 2.14(95%CI: 1.64-2.89). Multivariate regression analysis showed that age, baseline SOFA score, APACHE II score, history of acute renal insufficiency and history of coronary heart disease were independent risk factors for poor prognosis. Cumulative fluid balance on the day 3 and 7 after admission was also significantly and independently associated with poor prognosis. Conclusions: In patients with septic shock, the improvement of hemodynamics on the first day after ICU admission is significantly associated with the reduction of negative fluid balance on the 3rd and 7th day, organ dysfunction on the 3rd and 7th day, and the reduction of 28-day mortality. |
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