膈肌超声参数联合qSOFA评分预测老年脓毒症患者死亡的临床研究

Clinical study of diaphragmatic ultrasound parameters combined with qSOFA score in predicting death in elderly patients with sepsis

目的研究老年脓毒症患者膈肌超声参数联合快速序贯器官功能衰竭评估(qSOFA)评分对死亡的预测价值。方法回顾性分析2018年6月至2021年6月该院收治的138例老年脓毒症患者资料,根据入院后30 d预后情况分为存活组(n=84)和死亡组(n=54),比较两组临床资料差异,采用logistic回归分析老年脓毒症患者预后的影响因素,采用受试者工作特征(ROC)曲线分析qSOFA评分、膈肌超声参数预测老年脓毒症患者预后的价值。结果死亡组入院时血肌酐、降钙素原、急性生理和慢性健康评分Ⅱ(APACHEⅡ)、qSOFA评分高于存活组,膈肌增厚率、平静呼吸膈肌移动度、深呼吸膈肌移动度低于存活组,差异有统计学意义(P<0.05)。logistic回归分析显示,老年脓毒症患者预后的影响因素包括APACHEⅡ评分、qSOFA评分、膈肌增厚率、平静呼吸膈肌移动度、深呼吸膈肌移动度(P<0.05)。ROC曲线显示,qSOFA评分、膈肌增厚率、平静呼吸膈肌移动度、深呼吸膈肌移动度单独及联合均能预测老年脓毒症患者预后,且联合指标的预测效能优于单独指标。结论膈肌超声参数联合qSOFA对老年脓毒症患者预后有预测价值。

Objective To study the predictive value of diaphragmatic ultrasound parameters combined with quick sequential organ failure assessment(qSOFA)score on death among elderly patients with sepsis.Methods The data of 138 elderly patients with sepsis admitted to the hospital from June 2018 to June 2021 were retrospectively analyzed.According to the prognosis of 30 days after admission,the patients were divided into the survival group(n=84)and the death group(n=54).The difference of clinical data between the two groups was compared.The factors influencing the prognosis of elderly patients with sepsis were analyzed by logistic regression.The value of qSOFA score and diaphragmatic ultrasound parameters in predicting the prognosis of elderly patients with sepsis was analyzed by receiver operating characteristic(ROC)curve.Results Serum creatinine,procalcitonin,Acute Physiological and Chronic Health EvaluationⅡ(APACHEⅡ)score and qSOFA score on admission in the death group were higher than those in the survival group,but the rate of diaphragm thickening,diaphragm movement degree of calm breathing and deep breathing diaphragm movement degree were lower than those in the survival group,with statistical significance(P<0.05).logistic regression analysis showed that the factors influencing the prognosis of elderly patients with sepsis included APACHEⅡscore,qSOFA score,diaphragm thickening rate,diaphragm movement in calm breathing and deep breathing(P<0.05).ROC curve showed that qSOFA score,diaphragm thickening rate,diaphragm movement in calm breathing and deep breathing alone and the combined indicators of logistic regression equation could predict the prognosis of elderly patients with sepsis,and the combined indicators were better than the single indicator.Conclusion The combined use of diaphragmatic ultrasound parameters and qSOFA can predict the prognosis of elderly patients with sepsis.