血管加压素与重症患者预后的相关性研究

doi:10.16138/j.1673-6087.2021.03.009

摘要/Abstract

摘要：

目的：探讨血管加压素的使用对重症患者预后的影响。方法：回顾性分析美国重症医学信息监护数据集Ⅲ（Medical Information Mart for Intensive Care-Ⅲ,MIMIC-Ⅲ）重症患者的基本信息及临床资料,使用倾向性评分匹配法及COX多因素回归分析,探讨血管加压素对重症患者预后的影响。结果：共纳入MIMIC-Ⅲ中57 785例重症患者,其中有2 171例患者使用血管加压素。采用倾向性评分匹配方法对使用血管加压素治疗的患者和未使用血管加压素治疗的患者进行1∶1匹配,共1 168对患者匹配成功。匹配后使用血管加压素组与未使用血管加压素组相比,其院内死亡率、30 d死亡率、1年死亡率以及长期死亡率更高,住院时间及住重症监护病房（intensive care unit, ICU）时间均显著延长。COX多因素回归分析发现,血管加压素的使用是院内死亡率[风险比（hazard ratio, HR）=2.44, 95%置信区间（confidence interval,CI）：2.147~2.772, P<0.001]、30 d死亡率（HR=2.205, 95%CI：1.940~2.505, P<0.001）、1年死亡率（HR=1.999, 95%CI：1.781~2.242, P<0.001）以及长期死亡率（HR=1.891, 95%CI：1.698~2.107, P<0.001）增加的独立危险因素。结论：本研究利用倾向性评分匹配法及COX多因素回归分析进行大样本回顾性研究,发现血管加压素的使用是影响重症患者预后的独立危险因素。

关键词: 重症监护, 血管加压素, 危险因素, 死亡率

Abstract:

Objective To investigate the effect of vasopressin on the prognosis in the patients with critical condition. Methods The basic information and clinical data of the patients in critical condition in American intensive care database Medical Information Mart for Intensive Care-Ⅲ(MIMIC-Ⅲ) were retrospectively analyzed. The influence of vasopressin on the prognosis of the patients in critical condition was investigated by propensity score matching method and Cox multivariate regression analysis. Results A total of 57 785 patients in critical condition were selected from the MIMIC-Ⅲ database, in which 2 171 were treated with vasopressin. Propensity matching method was used to match 1∶1 between the patients treated with vasopressin and the patients treated without vasopressin. A total of 1 168 patients were successfully matched. The mortality of in-hospital, 30 d, 1-year and long-term in the group using vasopressin were higher than the group treated without vasopressin after matching, and the time staying in hospital and intensive care unit (ICU) were significantly longer in the vasopressin group after matching. Cox multivariate regression analysis showed that using vasopressin was an independent risk factor for increased in-hospital mortality[hazard ratio(HR)=2.44, 95% confidence interval(CI): 2.147-2.772, P<0.001], 30 d mortality (HR=2.205, 95% CI:1.940-2.505, P<0.001), 1-year mortality (HR=1.999, 95% CI: 1.781-2.242, P<0.001) and long-term mortality (HR=1.891, 95% CI: 1.698-2.107, P<0.001). Conclusions This study used propensity score matching method and Cox multivariate regression analysis to conduct a large sample retrospective study, and showed that the using vasopressin is an independent risk factor for the prognosis of the patients with critical condition.

Key words: Intensive care, Vasopressin, Risk factors, Mortality

中图分类号:

R459.7

李艳秀, 朱恩泽, 周春雷, 刘云, 左祥荣, 李京杭, 曹权. 血管加压素与重症患者预后的相关性研究[J]. 内科理论与实践, 2021, 16(03): 183-187.

LI Yanxiu, ZHU Enze, ZHOU Chunlei, LIU Yun, ZUO Xiangrong, LI Jinghang, CAO Quan. Relationship between vasopressin and prognosis in the patients with critical condition[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(03): 183-187.

图/表 6

表1

两组间基本特征及倾向性匹配后基本特征比较[$\bar{x}\pm s$/n(%)]

变量	倾向性匹配前		P	倾向性匹配后		P
变量	非血管加压素(n=55 614)	血管加压素(n=2 171)	P	非血管加压素(n=1 168)	血管加压素(n=1 168)	P
人口学资料
年龄(岁)	64.2±57.8	71.2±43.8	<0.001	71.2±43.8	70.7±41.6	0.721
年龄>60岁[n(%)]	29 321(52.7)	1 409(64.9)	<0.001	765( 65.5)	774(66.3)	0.720
男性[n(%)]	31 018(55.8)	1 280(59.0)	0.002	691( 59.2)	709(60.7)	0.467
BMI (kg/m²)	25.6±9.9	28.9±7.8	<0.001	29.1±7.8	28.9±8.1	0.104
BMI ≥28 kg/m²[n(%)]	9 708(37.4)	715(47.7)	<0.001	577( 49.4)	554(47.4)	0.362
实验室检查
白细胞计数(×10⁹/L)	13.7±10.4	18.0±16.5	<0.001	18.2±20.8	18.2±11.9	0.650
阴离子间隙(mmol/L)	15.6±4.6	19.4±6.7	<0.001	18.3±6.2	18.3±5.7	0.766
碳酸氢盐(mmol/L)	25.1±4.4	22.6±5.1	<0.001	23.8±4.7	23.0±4.8	0.512
胆红素(μmol/L)	2.1±4.2	3.6±6.7	<0.001	3.1±2.9	3.1±6.0	0.578
血糖(mmol/L)	9.9±5.8	11.9±6.5	<0.001	11.8±5.8	11.7±5.8	0.787
血红蛋白(g/ L)	125.0±26.0	11.08±21.0	<0.001	120.0±20.0	119.0±19.0	0.362
乳酸(mmol/L)	2.8±2.2	5.7±4.5	<0.001	4.7±4.0	4.8±3.6	0.434
血小板计数(×10⁹/L)	253.4±118.9	227.2±134.4	<0.001	239.6±137.8	238.1±133.6	0.991
重症评分
SOFA(分)	3.7±2.9	9.2±4.2	<0.001	8.5±3.7	8.8±3.6	0.051
SIRS(分)	2.5±1.1	3.3±0.8	<0.001	3.3±0.8	3.3±0.8	0.238
并发症[n(%)]
高血压	26 394(47.5)	1 004(46.2)	<0.001	568(48.6)	567(48.5)	0.989
糖尿病	13 412(24.1)	623(28.7)	<0.001	345(29.5)	325(27.8)	0.386
慢性心功能不全	12 996(23.4)	878(40.4)	<0.001	502(43.0)	500(42.8)	0.972
慢性肺心病	9 612(17.3)	409(18.8)	0.060	242(20.7)	227(19.4)	0.471
慢性肾功能不全	7 512(13.5)	447(20.6)	<0.001	242(20.7)	239(20.5)	0.917
CRRT[n(%)]	461(0.8)	471(21.7)	<0.001	192(16.4)	214(18.3)	0.252
机械通气[n(%)]	23 238(41.8)	1 972(90.8)	<0.001	1 073(91.9)	1 105(94.6)	0.060
结局指标[n(%)]
院内死亡率	4 548(8.2)	1 264(58.2)	<0.001	276(23.6)	577(49.4)	<0.001
30 d死亡率	5 517(9.9)	1 201(55.3)	<0.001	264(22.6)	536(45.9)	<0.001
1年死亡率	9 696(17.4)	1 396(64.3)	<0.001	381(32.6)	649(55.6)	<0.001
长期死亡率	14 250(25.6)	1 486(68.4)	<0.001	461(39.5)	707(60.5)	<0.001
住院时间(d)	10.1±12.3	16.0±16.4	<0.001	16.0±14.9	18.2±16.8	<0.001
住ICU时间(d)	4.7±9.5	11.1±12.6	<0.001	8.9±10.6	13.1±13.5	<0.001

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参考文献 10

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变量	HR	95% CI	P
年龄	1.004	1.003~1.005	<0.001
BMI≥28 kg/m²	0.847	0.761~0.943	0.002
血红蛋白	0.941	0.916~0.966	<0.001
乳酸	1.022	1.006~1.039	0.009
SOFA评分	1.059	1.041~1.078	<0.001
机械通气	1.873	1.587~2.211	<0.001
SIRS评分	1.247	1.161~1.339	<0.001
使用血管加压素	2.440	2.147~2.772	<0.001

变量	HR	95% CI	P
年龄	1.004	1.003~1.005	<0.001
BMI≥28 kg/m²	0.814	0.733~0.905	<0.001
血红蛋白	0.944	0.920~0.969	<0.001
乳酸	1.023	1.006~1.040	0.007
SOFA评分	1.064	1.047~1.082	<0.001
慢性肺心病	1.182	1.042~1.340	0.009
机械通气	1.352	1.167~1.566	<0.001
SIRS评分	1.208	1.129~1.293	<0.001
使用血管加压素	2.205	1.940~2.505	<0.001

变量	HR	95% CI	P
年龄	1.004	1.003~1.005	<0.001
BMI≥28 kg/m²	0.786	0.719~0.860	<0.001
血红蛋白	0.919	0.898~0.940	<0.001
乳酸	1.031	1.016~1.047	<0.001
SOFA评分	1.056	1.041~1.071	<0.001
慢性心功能不全	1.121	1.022~1.230	0.016
慢性肺心病	1.128	1.013~1.257	0.028
CRRT	1.173	1.019~1.349	0.026
机械通气	1.211	1.078~1.361	0.001
SIRS评分	1.186	1.121~1.253	<0.001
使用血管加压素	1.999	1.781~2.242	<0.001

变量	HR	95%CI	P
年龄	1.004	1.003~1.005	<0.001
BMI≥28 kg/m²	0.805	0.742~0.873	<0.001
血红蛋白	0.925	0.907~0.945	<0.001
乳酸	1.035	1.021~1.049	<0.001
SOFA评分	1.047	1.033~1.061	<0.001
高血压	0.921	0.850~0.998	0.045
慢性心功能不全	1.178	1.082~1.283	<0.001
慢性肺心病	1.194	1.084~1.315	<0.001
CRRT	1.178	1.028~1.349	0.018
机械通气	1.176	1.060~1.305	0.002
SIRS评分	1.165	1.108~1.224	<0.001
使用血管加压素	1.891	1.698~2.107	<0.001

变量	OR	95%CI	P
年龄>60岁	1.230	1.052~1.438	0.010
白细胞	1.005	1.001~1.010	0.023
乳酸	1.095	1.074~1.117	<0.001
SOFA评分	1.359	1.331~1.387	<0.001
慢性心功能不全	1.657	1.441~1.904	<0.001
SIRS评分	1.261	1.157~1.375	<0.001