李娟 孟晓华 杨雯

摘  要：目的  探究序貫器官衰竭评分（SOFA）联合降钙素原PCT清除率（PCTc-48h）、乳酸清除率（LACc-48h）对老年感染性休克患者病情评估及预后判断中的价值。方法  回顾性分析2018年1月～2020年5月山东省泰山医院收治的110例老年感染性休克患者临床资料。按照28 d预后将患者分为存活组（60例）和死亡组（50例），对两组临床资料等指标进行分析，通过logistic回归分析各预测因子对预后的影响。结果  两组性别、年龄、体质量指数、吸烟史、高血脂发生率、高血压发生率经比较，差异均无统计学意义（P>0.05）;存活组急性生理与慢性健康量表Ⅱ（APACHEⅡ）评分与SOFA评分均低于死亡组，差异均具有统计学意义（P<0.05）;存活组PCTc-48h、LACc-48h均高于死亡组，差异均具有统计学意义（P<0.05）;Logistic多因素分析结果提示，SOFA评分、PCTc-48h、LACc-48h是患者预后有关的独立危险因素（P<0.05）。结论  SOFA评分、PCTc-48h、LACc-48h是评估老年感染性休克患者病情严重程度及预后的预测指标，三者联合应用具有更高的评估价值。

关键词：序贯器官衰竭评分;感染性休克;降钙素原清除率;乳酸清除率

中图分类号：R681    文献标识码：A    文章编号：1009-8011（2021）-17-0001-03

The value of sequential organ failure score combined with procalcitonin clearance and lactate clearance in evaluating the prognosis of elderly patients with septic shock

LI Juan  MENG Xiao-hua  YANG Wen

（Department of Critical Medicine， Taishan Hospital， Shandong Taian， 271000， China）

Abstract： Objective  To explore the value of sequential organ failure score（SOFA） combined with procalcitonin PCT clearance（PCTc-48h） and lactate clearance （LACc-48h） in evaluating the condition and prognosis of elderly patients with septic shock. Methods  The clinical data of 110 elderly patients with septic shock treated in Taishan hospital of Shandong province from January 2018 to May 2020 were analyzed retrospectively. According to the 28-day prognosis， the patients were divided into survival group（n=60） and death group（n=50）. The clinical data and other indexes of the two groups were analyzed. The influence of each predictor on the prognosis was analyzed by logistic regression. Results  There was no significant difference in gender， age， body mass index， smoking history， incidence of hyperlipidemia and hypertension between the two groups（P>0.05）; The scores of acute physiology and chronic health scale Ⅱ（APACHE Ⅱ） and SOFA in the survival group were lower than those in the death group（P<0.05）; PCTc-48h and LACc-48h in the survival group were higher than those in the death group（P<0.05）; logistic multivariate analysis showed that SOFA score， PCTc-48h and LACc-48h were independent risk factors related to prognosis （P<0.05）. Conclusion  SOFA score， PCTc-48h and LACc-48h are predictive indexes for evaluating the severity and prognosis of elderly patients with septic shock. The combined application of the three has higher evaluation value.

Keywords： sequential organ failure score; septic shock; procalcitonin clearance; lactate clearance

感染性休克是脓毒症患者机体出现严重细胞、循环、代谢紊乱的情况，相较于单纯脓毒癥，其病死的风险更高[1]。感染性休克患者存在血糖水平异常升高的情况，而患者的高血糖状态会加快代谢的速度，出现负氮平衡，加重感染，影响机体内环境平衡，降低免疫功能，神经细胞坏死速度加快，从而影响患者的预后，增加了疾病病死率[2-3]，因此，加强患者预后影响因素的分析，并实施针对性的干预措施改善患者的预后，具有重要的临床意义。基于此，本研究通过检测老年感染性休克患者序贯器官衰竭评分（sequential organ failure assessment，SOFA）联合降钙素原PCT清除率（procalcitonin，PCTc-48h）、乳酸清除率（Lactate clearance，LACc-48h），比较各指标对老年感染性休克患者病情严重程度和预后评估的价值，为老年感染性休克患者的诊疗提供依据。