摘要
目的探讨舌色联合舌下微循环对感染性休克患者预后的预测价值。方法选择2016年5月—2017年5月南京中医药大学附属中西医结合医院重症医学科收治的感染性休克患者65例,根据患者28天预后情况将患者分为存活组(35例)及死亡组(30例)。观察患者早期复苏6 h后舌色、平均动脉压(MAP)、中心静脉血氧饱和度(Scv O2)、中心静脉压(CVP)、去甲肾上腺素用量(NE)及动脉乳酸(Lac)变化;应用旁流暗视野技术(SDF)测定患者舌下微循环的总血管密度(TVD)、灌注血管密度(PVD)、灌注血管比例(PPV)、微血管流动指数(MFI);记录患者入院当日急性生理与慢性健康Ⅱ(APACHEⅡ)评分;采用多因素Logistic回归分析筛选患者死亡的危险因素,并通过受试者工作特征曲线(ROC)评价各项指标变化预测患者预后的价值。结果两组复苏后MAP、ScvO_2、CVP及NE用量比较,差异无统计学意义(P>0. 05);与死亡组比较,存活组Lac及APACHEⅡ评分明显降低(P <0. 05),TVD、PVD、PPV和MFI明显升高(P <0. 01,P <0. 05);存活组红舌出现几率较高,死亡组白舌及紫舌出现频率明显增多(P <0. 05)。多因素Logistic回归分析显示,APACHEⅡ评分、舌色及PPV是感染性休克患者28天生存率的独立预后因素(P <0. 05)。以舌色及PPV作为联合预测因子,ROC曲线分析显示,动脉血Lac、APACHEⅡ评分及舌色联合PPV对感染性休克患者预后均有预测价值,其中舌色联合PPV的ROC;曲线下面积(AUC)最大为0. 795;当截断值为紫舌及PPV <67%时预测感染性休克患者28天死亡的敏感度为76. 67%,特异度为71. 43%。结论舌色联合舌下微循环与感染性休克患者预后相关性较好,可作为评估感染性休克患者28天生存的预后指标。
Objective To explore the prognostic value of the tongue color combined sublingual microcirculation in critical patients with septic shock. Methods Sixty-five patients with septic shock in the department of critical care medicine,affiliated hospital of integrated traditional Chinese and Western medicine,Nanjing University of Chinese medicine from May2016 to May 2017 were enrolled in this observational study. According to the 28-day mortality,the patients were assigned to survivor group( 35 cases) and non-survivor group( 30 cases). After the early 6 hours resuscitation,the tongue color,mean arterial pressure( MAP),central venous blood oxygen saturation( ScvO2),central venous pressure( CVP),the dosage of norepinephrine( NE) and peripheral arterial lactate( Lac) were observed,sublingual microcirculation was measured simultaneously by sidestream dark field( SDF) imaging device,including total vascular density( TVD),perfused vascular density( PVD),proportion of perfused vessels( PPV),and microvascular flow index( MFI). Acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) score were obtained on the day of enrollment. Multiple Logistic regression was conducted to identify the risk factors,and the receiver operating characteristic curve( ROC) was plotted to assess the value of tongue color combined sublingual microcirculation in predicting the outcome. Results There was no significant difference in MAP,ScvO2,CVP and the dosage of NE between the two groups after resuscitation(P > 0. 05). Compared with the non-survivor group,Lac and APACHEⅡscores in the survivor group were significantly lower(P < 0. 05),TVD,PVD,PPV and MFI were significantly higher(P < 0. 01,P < 0. 05). The frequency of red tongue were significantly higher in survivor group,meanwhile the frequency of white tongue and purple tongue was significantly more in non-survivor group(P < 0. 05). Multiple Logistic regression analysis showed that APACHEⅡscore,tongue color and PPV were the independent risk factors for the 28-day mortality(P < 0. 05). ROC analysis showed that Lac,APACHEⅡ score and tongue color combined with PPV had predictive value for prognosis in patients with septic shock,while the maximum area under the ROC curve( AUC) of tongue color combined PPV was 0. 795,When the best cut-off value was purple and PPV < 67. 0% as a predictor of 28-day mortality,the sensitivity was76. 67%,and specificity was 71. 43%. Conclusions Tongue color combined PPV had a good correlation with the prognosis of septic shock. It could be used to estimate poor outcome of patients with septic shock.
作者
高伟
朱启勇
倪海滨
张家留
周丹丹
殷丽萍
张丰
陈浩
张蓓蓓
李伟
GAO Wei;ZHU Qi-yong;NI Hai-bin;ZHANG Jia-liu;ZHOU Dan-dan;YIN Li-ping;ZHANG Feng;CHEN Hao;ZHANG Bei-bei;LI Wei(Department of Critical Care Medicine,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing (210028))
出处
《中国中西医结合杂志》
CAS
CSCD
北大核心
2019年第2期189-193,共5页
Chinese Journal of Integrated Traditional and Western Medicine
基金
国家自然科学基金资助项目(No.81673932)
江苏省中医药局科技项目(No.YB2015040)
中国中医科学院江苏分院青年课题(No.JSBY1307)
关键词
感染性休克
舌色
舌下微循环
旁流暗视野技术
预后
septic shock
tongue color
sublingual microcirculation
sidestream dark-field imaging
prognosis
