液体负平衡对重症肺炎患者预后的影响

Negative fluid balance can reduce the 30-day mortality after entering ICU of severe pneumonia patients:a retrospective cohort study

目的研究不同液体平衡策略对重症肺炎患者预后的影响并探求可能的影响途径,并为重症肺炎患者早期液体治疗合理化提供依据。方法回顾性分析2017年1月至2019年8月间入住江苏省人民医院急诊监护病房(EICU)及呼吸监护病房(RICU)成人重症肺炎患者共89例。分析死亡组(n=35)和存活组(n=54)患者的临床数据差异,并采用二元Logistic回归分析重症肺炎患者入ICU后30 d病死率的相关危险因素。根据入ICU后前3 d出入量将患者分为液体正平衡组(n=48)(positive fluid balance,PFB,即入ICU后前3 d总入量>总出量)和液体负平衡组(n=41)(negative fluid balance,NFB,即入ICU后前3 d总入量<总出量),并比较两组在入院后5 d内肝肾功能、电解质的差异。采用Kaplan-Meier生存曲线液体正平衡组和液体负平衡组患者入ICU后30 d生存率的差异。结果年龄(OR=1.060,95%CI:1.018~1.104,P=0.005)、呼吸机依赖(OR=6.679,95%CI:1.218~36.620,P=0.029)、血管活性药物(OR=21.068,95%CI:4.654~95.376,P<0.001)、入ICU 24 h内新发高氯血症(OR=21.714,95%CI:1.059~445.008,P=0.046)为重症肺炎患者入ICU后30 d病死率的相关危险因素。NFB组患者的入ICU后5 d内(D1-D5)血肌酐、血尿素氮、血钠浓度、血氯浓度低于PFB组(P<0.05)。NFB组在D3-D5血钙浓度高于PFB组(P<0.05)。NFB组患者入ICU后30d生存率高于PFB组(P<0.001)。结论液体负平衡可降低重症肺炎患者血氯浓度、改善肾功能、降低病死率。

Objective To study the effects of different fluid balance strategies on severe pneumonia patients and explore the possible influence path in order to optimize fluid treatment for severe pneumonia patients.Methods A total of 89 adult patients with severe pneumonia admitted to EICU and RICU of Jiangsu Provincial Hospital from January 2017 to August 2019 were retrospectively analyzed.The differences of clinical data between the death group(n=35)and the survival group(n=54)were analyzed.Multivariate logistic regression analysis was used to identify predictors of 30-day mortality after entering ICU of severe pneumonia patients.Patients were divided into a positive fluid balance(PFB)group(n=48)and a negative fluid balance(NFB)group(n=41).Kaplan-Meier survival curve was used to analyze the difference of 30-day survival rate between the PFB and NFB groups.Results Age(OR=1.060,95%CI:1.018-1.104,P=0.005),ventilator dependency(OR=6.679,95%CI:1.218-36.620,P=0.029),vasoactive agents(OR=21.068,95%CI:4.654-95.376,P<0.001),and new hyperchloremia occurred within 24 h after admission to the ICU(OR=21.714,95%CI:1.059-445.008,P=0.046)were the risk factors for severe pneumonia patients'30-day mortality after entering ICU.The concentrations of creatinine,urea nitrogen,sodium and chlorine of the NFB patients were lower than those of the PFB patients within 5 days after admission to ICU(day 1-day 5)(P<0.05).The serum calcium concentrations of the NFB patients were higher than those of the PFB patients on day 3-5(P<0.05).The 30-day survival rate was significantly higher in the NFB patients than in the PFB patients(P<0.001).Conclusions The strategy of negative fluid balance can reduce serum chlorine concentration,improve renal function and reduce mortality in patients with severe pneumonia.