CAJ | 학술논문

目的评价感染性休克后期血管加压素分泌能力预测患者转归的准确性,探讨其与感染性休克预后的关系.方法选取入住本院重症监护病房(ICU)的感染性休克后期患者55例,年龄20 ～ 64岁,性别不限,测定其血管加压素分泌能力.测定方法:静脉输注3％氯化钠600 ml,输注时间2h,测定输注前后血清钠(mmol/L)及血清血管加压素(VP,ng/L)的浓度,以其差值的比值(△VP/△Na)反映其分泌能力.根据△VP/△Na水平,将患者分为VP分泌能力异常组(△VP/△Na≤0.5ng/mmol)及正常组(△VP/△Na＞0.5 ng/mmol),在测试VP分泌能力前即刻,取静脉血样,测定血清乳酸及C反应蛋白(CRP)浓度,记录入选时血管活性药物用量及28 d病死率.结果异常组30例(54％),正常组25例(46％).与正常组比较,异常组血清乳酸、CRP浓度、多巴胺或去甲肾上腺素用量明显升高、28 d病死率明显升高(40％比67％,P＜0.01或0.05).ROC曲线分析显示,以△VP/△Na0.5 ng/mmol作为判定预后的标准时,其灵敏度66.7％,特异度64.0％,曲线下面积0.828.结论感染性休克后期血管加压素分泌能力可明显影响患者的预后.
목적 평개감염성휴극후기혈관가압소분비능력예측환자전귀적준학성,탐토기여감염성휴극예후적관계.방법 선취입주본원중증감호병방(ICU)적감염성휴극후기환자55례,년령20 ～ 64세,성별불한,측정기혈관가압소분비능력.측정방법:정맥수주3％록화납600 ml,수주시간2h,측정수주전후혈청납(mmol/L)급혈청혈관가압소(VP,ng/L)적농도,이기차치적비치(△VP/△Na)반영기분비능력.근거△VP/△Na수평,장환자분위VP분비능력이상조(△VP/△Na≤0.5ng/mmol)급정상조(△VP/△Na＞0.5 ng/mmol),재측시VP분비능력전즉각,취정맥혈양,측정혈청유산급C반응단백(CRP)농도,기록입선시혈관활성약물용량급28 d병사솔.결과 이상조30례(54％),정상조25례(46％).여정상조비교,이상조혈청유산、CRP농도、다파알혹거갑신상선소용량명현승고、28 d병사솔명현승고(40％비67％,P＜0.01혹0.05).ROC곡선분석현시,이△VP/△Na0.5 ng/mmol작위판정예후적표준시,기령민도66.7％,특이도64.0％,곡선하면적0.828.결론 감염성휴극후기혈관가압소분비능력가명현영향환자적예후.
Objective To evaluate the accuracy of vasopressin (VP) secretion in the late phase of septic shock for predicting patient outcomes and further investigate its relationship with the prognosis of septic shock.Methods Fifty-five patients presented at late phase of septic shock,who were admitted to the intensive care unit of our hospital,were enrolled.Their VP secretion was measured.The method for measurement was as follows:3％ sodium chloride solution 600 ml was infused over 2 h,serum concentrations of VP and sodium were measured before and after infusion,the difference in VP before and after infusion (△VP) and in Na before and after infusion (△Na) was calculated,and △VP/△Na was used to reflect VP secretion.The patients were divided into either abnormal secretion of VP group (△ VP/△ Na ≤ 0.5 ng/mmol) or normal secretion of VP group (△VP/△Na＞0.5 ng/mmol) according to △VP/△Na ratio.Immediately before testing VP secretion,venous blood samples were collected for determination of serum lactic acid and C-reactive protein concentrations.The consumption of vasoactive drugs at the moment of enrollment and 28-day fatality rate were recorded.Results There were 30 cases in abnormal group (54％) and 25 cases in normal group (46％).Compared with normal group,the serum lactic acid,C-reactive protein concentrations and consumption of dopamine or norepinephrine were significantly increased,and the 28-day fatality rate was increased (67％ vs 40％) in abnormal group.ROC curve analysis showed that when △VP/△Na 0.5 ng/mmol was used as the criteria for determining prognosis,the sensitivity was 66.7％,specificity was 64.0％,and the area under the ROC curve was 0.828.Conclusion VP secretion in the late phase of septic shock may affect patient prognosis.