血红蛋白与脓毒症休克患者死亡率的相关性

Correlation between hemoglobin and mortality in patients with septic shock

目的探讨血红蛋白(Hb)与脓毒症休克患者死亡率的相关性。方法根据入院时Hb水平将225例脓毒症休克患者分为4组:Hb>90 g/L组105例、80 g/L<Hb≤90 g/L组47例、70 g/L<Hb≤80 g/L组40例、Hb≤70 g/L组33例。患者入院确诊后均接受集束化治疗。比较4组患者的性别、年龄、疾病史、感染部位、入院时首次生化检查结果、入院后序贯器官衰竭评估(SOFA)评分、急性心理与慢性健康状况Ⅱ(APACHEⅡ)评分、治疗情况及预后。采用多因素回归分析探讨脓毒症休克患者90 d死亡的影响因素。结果4组患者性别、年龄、疾病史、感染部位、血小板计数、肌酐及入院时接受液体复苏(<3 h)、抗生素(<1 h)、血管加压素、机械通气及肾脏替代疗法治疗患者比例比较差异均无统计学意义(P>0.05)。4组患者白细胞计数、C反应蛋白水平、SOFA评分、APACHEⅡ评分及接受红细胞、新鲜冷冻血浆、浓缩血小板输血及死亡患者比例比较差异均有统计学意义(P<0.05)。多因素回归分析结果显示,Hb、SOFA评分和输注红细胞为脓毒症休克患者90 d死亡的独立影响因素(P<0.05)。结论Hb水平降低为脓毒症休克患者死亡的影响因素,输注红细胞可改善其预后。

Objective To explore the relationship between hemoglobin(Hb)and mortality in patients with septic shock.Methods According to the Hb level at admission,225 patients with septic shock were divided into 4 groups:Hb>90 g/L group(105 cases),80 g/L<Hb≤90 g/L group(47 cases),70 g/L<Hb≤80 g/L group(40 cases),Hb≤70 g/L group(33 cases).All patients received cluster treatment after admission to the hospital.Age,gender,disease history,infection site,first biochemical examination results at admission,sequential organ failure assessment(SOFA)score after admission,acute psychological and chronic health statusⅡ(APACHEⅡ)score,treatment status and prognosis among 4 groups were compared.Multivariate regression analysis was used to explore the influencing factors of 90-day death in patients with septic shock.Results Gender,age,disease history,infection site,platelet count,creatinine and proportion of patients who received fluid resuscitation(<3 h),antibiotics(<1 h),vasopressin,mechanical ventilation and renal replacement therapy on admission were not significantly different among 4 groups(P>0.05).White blood cell count,C reactive protein level,SOFA score,APACHEⅡscore and proportion of patients who received red blood cell,fresh frozen plasma,platelet concentrate transfusion and death among 4 groups were significantly different(P<0.05).Multivariate regression analysis showed that Hb,SOFA score and red blood cell infusion were independent influencing factors of 90 d death in patients with septic shock(P<0.05).Conclusion Decreased Hb level is a influencing factor of death in patients with septic shock,and red blood cell transfusion can improve their prognosis.