超声介入联合支持治疗对糖尿病合并重症胆囊炎患者的疗效及预后风险评估

Evaluation of the curative effect and prognostic risk of ultrasound intervention combined with supportive therapy in diabetic patients with severe cholecystitis

目的探索超声介入联合支持治疗对糖尿病合并重症胆囊炎患者的疗效及进展为脓毒症休克的风险因子。方法长回顾性选取2021年1月至2021年12月北京友谊医院急诊治疗的81例糖尿病合并重症胆囊炎患者,根据是否进展为脓毒症休克分为毒症休克组(n=40)和脓毒症组(n=41)。收集患者的临床资料,分析超声介入联合支持治疗对糖尿病合并重症胆囊炎的疗效,采用logistic回归及受试者工作特征(ROC)曲线预测糖尿病合并重症胆囊炎患者进展为脓毒症休克的风险因素。结果脓毒症组胆汁培养5例阳性,血培养2例阳性;脓毒症休克组胆汁培养28例阳性,血培养12例阳性。脓毒症组治疗前糖化血红蛋白(HbA1c)浓度,胆囊宽度和最终的28d全因病死率均较脓毒症休克组低(均P<0.05)。脓毒症组治疗前降钙素原(PCT)、乳酸(Lac)、休克指数(SI)、序贯器官衰竭评估(SOFA)评分均低于脓毒症休克组(均P<0.05);而平均动脉压(MAP)高于脓毒症休克组(P<0.01)。脓毒症组及脓毒症休克组患者经过治疗后,白细胞(WBC)、中性粒细胞比例(NEUT%)、血小板(PLT)、PCT、C反应蛋白(CRP)、总胆红素(TBil)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、MAP、心率(HR)、Lac、SI、SOFA评分有所改善(均P<0.05)。治疗后脓毒症组D-二聚体(D-dimer)下降(P<0.05),但脓毒症休克组治疗后的D-dimer与治疗前比较差异无统计学意义(P=0.7295)。多因素logistic回归显示HbAic、PCT、MAP是糖尿病合并重症胆囊炎患者发生脓毒症休克的独立风险因素(OR=9.19、1.32、0.58,均P<0.05)。SOFA评分、HbA1。与PCT预测糖尿病患者因胆囊炎发生脓毒症休克的R0C曲线下面积为0.878、0.9180.715。结论超声介入联合支持治疗可以明显缓解重症胆囊炎患者病情,但仍需要尽早干预降低死亡风险。HbA1。和PCT可以作为糖尿病合并重症胆囊炎发生脓毒症休克的独立风险因素。

Objective To explore the therapeutic effect of ultrasound intervention combined with support in the treatment of diabetic patients with severe cholecystitis and the risk factors of septic shock.Methods A total of 81 diabetic patients with severe cholecystitis treated in the emergency department of Beijing Friendship Hospital from January to December 2021 were retrospectively selected and divided into sepsis group(n=41)and septic shock group(n=40).The clinical data of the patients were collected,and the curative effect of ultrasound intervention combined with supportive treatment for diabetic patients with severe cholecystitis was analyzed.logistic regression and receiver operating characteristic(ROC)curve were used to predict the risk factors for diabetic patients with severe cholecystitis to develop septic shock.Results In the sepsis group,5 cases were positive in bile culture and 2 cases were positive in blood culture.In the septic shock group,28 cases were positive in bile culture and 12 cases were positive in blood culture.The concentration of glycosylated hemoglobin(HbAr.)before treatment,gallbladder width and final 28-day all-cause mortality in the sepsis group were lower than those in the shock group(all P<0.05).Before treatment,procalcitonin(PCT),lactic acid(Lac),shock index(SI)and Sequential Organ Failure Assessment(SOFA)scores in the sepsis group were lower than those in the sepsis shock group(all P<0.05).The mean arterial pressure(MAP)was higher than that of the shock group(P<0.01).After treatment for the sepsis group and the septic shock group,white blood cell(WBC),neutrophilic granulocyte percentage(NEU%),platelet(PLT),PCT,C-reactive protein(CRP),total bilirubin(TBil),alanine aminotransferase(ALT),aspartate aminotransferase(AST),MAP,heart rate(HR),Lac,SI and SOFA scores were improved(all P<0.05).After treatment,D-dimer decreased in the sepsis group(P<0.05),but there was no significant difference in D-dimer between the sepsis shock group and before treatment(P=0.7295).Multivariate logistic regression showed that HbAie,PCT and MAP were independent risk factors for septic shock in diabetic patients with severe cholecystosis(0R=9.19,1.32,0.58,all P<0.05).The area under ROC curve of SOFA score,HbAre and PCT for predicting septic shock due to cholecystitis in diabetic patients were 0.878,0.918 and 0.715.Conclusions Ultrasound intervention combined with supportive treatment can significantly alleviate the condition of patients with severe cholecystitis,but early intervention is still needed to reduce the risk of death.HbAe and PCT can be used as independent risk factors for septic shock in diabetic patients with severe cholecystitis.