【摘要】 目的评价血清钠浓度对肠瘘合并腹腔感染病人死亡情况的预测价值。方法选择2012年1月至2013年1月南京军区南京总医院普通外科收治的162例肠瘘合并腹腔感染病人作为推导队列,根据28 d死亡情况将病人分为生存组(119例)和死亡组(43例)。监测病人入院当天及入院第3、7天的各项生化指标[血清钠浓度([Na+])、血清降钙素原(PCT)]。以[Na+]为例:[Na+]0、[Na+]3、[Na+]7分别为入院当天和入院后第3、7天的[Na+];Δ[Na+]3=[Na+]3-[Na+]0;Δ[Na+]7=[Na+]7-[Na+]0;Δ[Na+]7-3=[Na+]7-[Na+]3。其余指标以此类推。使用ROC曲线分析各指标对预后的影响。同时,选择2013年1-10月的116例相关病人作为验证队列,对各指标的预测价值进行验证。结果 ROC曲线分析表明,[Na+]7>147.5 mmol/L和Δ[Na+]7>5.2 mmol/L可准确地预测病人的死亡情况。[Na+]7:敏感度81.2%,特异度87.7%,AUC=0.872(P<0.001);Δ[Na+]7:敏感度81.3%,特异度83.6%,AUC=0.836(P<0.001)。联合多个指标预测的准确度最高:[Na+]7>147.5 mmol/L+Δ[Na+]7>5.2 mmol/L+ΔPCT7<5.3ng/m L(AUC=0.899,P<0.001)。结论动态监测血清钠浓度可预测肠瘘合并腹腔感染病人的28 d死亡情况,高钠血症和血钠波动幅度过大是敏感的预警指标,应该在危重症病人的临床监护中加以重视。更多还原

【Abstract】 ObjectiveTo evaluate the predictive value of serum sodium determination for mortality in enteric fistulapatients complicated with sepsis.MethodsA total of 162 enteric fistula patients complicated with sepsis admittedbetween January 2012 and January 2013 in Department of General Surgery, Nanjing General Hospital of NanjingMilitary Command of PLA were analyzed. Patients were divided into survivors group(119 patients)and nonsurvivorsgroup(43 patients)according to their 28-day outcomes. Laboratory variables([Na+] and PCT)on day 3 and day 7 afteradmission were observed. All the variables were analyzed by ROC curve. A total of 116 patients admitted betweenJanuary 2013 and October 2013 were classified as the control group and determination value of all the variables wereanalyzed.ResultsROC analysis showed that [Na+]7>147.5 mmol/L and Δ[Na+]7>5.2 mmol/L were reliable predictors([Na+]7: 81.2% sensitivity,87.7% specificity,AUC=0.872,P <0.001. Δ[Na+]7: 81.3% sensitivity,83.6% specificity,AUC=0.836,P<0.001) for mortality. The combination form([Na+]7>147.5 mmol/L+Δ[Na+]7>5.2 mmol/L + ΔPCT7<5.3 ng/m L,AUC=0.899,P<0.001)had highest predictive value.ConclusionSerum sodium is a reliable predictor for 28-daymortality in enteric fistula patients complicated with sepsis. Hypernatremia and excessive volatility of serum sodium arethe sensitive warning indicators. Surgeons should pay attention to the parameters in the critical care.更多还原