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

Accuracy of vasopressin secretion in the late phase of septic shock for predicting patient outcomes

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.

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.