衰弱指数对老年脓毒症患者血必净治疗后转归的影响

Effect of Asthenia Index on the Outcome of Xuebijing Treatment in Elderly Patients with Sepsis

目的研究衰弱指数对老年脓毒症患者血必净治疗后转归的影响。方法前瞻性研究,纳入开封市人民医院于2021年3月至2022年12月收治的90例老年脓毒症患者为研究对象。于入院当天,通过一般资料调查表统计所有患者年龄、体重、心率、糖尿病史、性别等基本信息;抽取空腹静脉血,检测患者白细胞计数、C反应蛋白、降钙素原、血肌酐、血小板计数等;于入院当天,评估老年脓毒症患者衰弱指数,并根据衰弱指数将90例老年脓毒症患者分为无衰弱组、衰弱前期组、衰弱组。所有患者入院后均接受营养支持、预防应激性溃疡、液体复苏等常规治疗,且在常规治疗基础上加用血必净。记录所有患者治疗28 d内转归情况(存活、病死)。通过Cox回归分析,探究衰弱指数对老年脓毒症患者血必净治疗转归的影响。结果90例老年脓毒症患者中无衰弱29例,占比32.22%;衰弱前期34例,占比37.78%;衰弱27例,占比30.00%。3组年龄对比,衰弱组>衰弱前期组>无衰弱组,差异有统计学意义(P<0.05);3组间体温、心率、糖尿病史、白细胞计数、血肌酐等对比,差异无统计学意义(P>0.05)。治疗28 d内,90例老年脓毒性患者中病死24例,占比26.67%,其中无衰弱组4例,衰弱前期组8例,衰弱组12例;3组患者病死率比较,差异有统计学意义(log-rankχ^(2)=7.137,P=0.028)。经Cox模型分析,衰弱指数会对老年脓毒症患者血必净治疗转归产生影响(HR>1,P<0.05)。结论衰弱指数会对老年脓毒症患者血必净治疗转归产生影响,且衰弱指数越高,老年脓毒症患者转归越差。

Objective To study the effect of asthenia index on the outcome of Xuebijing treatment in elderly patients with sepsis.Methods A prospective study included 90 elderly patients with sepsis admitted to Kaifeng People’s Hospital from March 2021 to December 2022.On the day of admission,the general information of all patients,such as age,weight,heart rate,history of diabetes and gender were collected through the general data questionnaire.The fasting venous blood was taken to detect the white blood cell count,C-reactive protein,procalcitonin,blood creatinine,platelet count,etc.On the day of admission,the frailty index of elderly patients with sepsis was evaluated,and according to the frailty index,90 elderly patients with sepsis were divided into three groups:non-asthenia,pre-asthenia and asthenia.All patients received routine treatment such as nutritional support,prevention of stress ulcer and fluid resuscitation after admission,and Xuebijing was added on the basis of routine treatment.The outcome of all patients within 28 days of treatment(survival,death)were recorded.Through Cox regression analysis,the effect of asthenia index on the outcome of Xuebijing treatment in elderly patients with sepsis was explored.Results Among the 90 elderly patients with sepsis,29 patients had no weakness,accounting for 32.22%,and 34 cases(37.78%)were in pre-asthenia stage,and 27 cases were in the asthenia group,accounting for 30.00%.The age of the three groups showed that the asthenia group>the pre-asthenia group>the non-asthenia group,with a statistically significant difference(P<0.05).There was no statistically significant difference in temperature,heart rate,history of diabetes,white blood cell count,blood creatinine among the three groups(P>0.05).Within 28 days of treatment,24 of the 90 elderly patients with sepsis died,accounting for 26.67%,including 4 in the non-asthenia group,8 in the pre-asthenia group,and 12 in the asthenia group.There was a statistically significant difference in mortality among the three groups(log-rankχ^(2)=7.137,P=0.028).According to Cox model analysis,the debility index would affect the outcome of Xuebijing treatment in elderly patients with sepsis(HR>1,P<0.05).Conclusion The debility index will affect the outcome of Xuebijing treatment in elderly patients with sepsis,and the higher the debility index,the worse the outcome of elderly patients with sepsis.