在移动重症监护室照顾的败血症休克患者的医院前脉压和死亡率
Romain Jouffroy1,2,3,4,5, Basile Gilbert6, Jean Pierre Tourtier7
1Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique Hôpitaux Paris and Paris Saclay University, 9 avenue Charles De Gaulle, Boulogne-Billancourt, 92100, France. romain.jouffroy@gmail.com.
BMC emergency medicine
|August 25, 2023
概括
在感染性休克患者中,低初始脉冲压 (iPP) 低于40mmHg与更高的30天死亡率有关. 然而,在医院前护理期间的正脉压变化 (dPP) 与改善的生存率有关.
科学领域:
- 关键护理医学 关键护理医学
- 紧急医疗 紧急医疗
- 心血管生理学心血管生理学
背景情况:
- 败血性休克管理涉及抗生素和血液动力学优化,目标是65mmHg的平均动脉压.
- 由于监测设备有限,在医院前设置中评估心脏输出具有挑战性.
- 这项研究调查了医院前的血液动力学参数,以预测性休克死亡率.
研究的目的:
- 为了评估初始脉冲压 (iPP) 和30天死亡率在医院前感染性休克患者之间的关联.
- 确定医院前脉冲压变化 (dPP) 与性休克30天死亡率之间的关系.
- 评估iPP和dPP在预测移动重症监护病房管理的败血症休克结果方面的实用性.
主要方法:
- 从2016年5月至2021年12月,对530名接受移动重症监护室 (MICU) 治疗的败血性休克患者进行了回顾性分析.
- 从最初的SBP和DBP计算的初始脉压 (iPP);根据在医院前护理期间的PP变化计算的脉压变化 (dPP).
- 倾向性得分匹配用于控制混因子,在评估 iPP < 40mmHg,阳性dPP和30天死亡率之间的关系时进行控制.
主要成果:
- 在分析的败血症休克患者中,30天死亡率为31%.
- 低于40mmHg的初始脉冲压 (iPP) 与30天死亡风险增加1.61倍有关 (aHR为1.61 [1.03-2.51]).
- 阳性脉压变化 (dPP) 与30天死亡风险降低0.56倍有关 (aHR为0.56 [0.36-0.88]).
结论:
- 较低的初始脉冲压 (iPP < 40mmHg) 与30天死亡率增加有关.
- 在医院前护理期间的正脉压变化 (dPP) 与30天死亡率的降低有关.
- 负dPP可能表明,尽管在医院前进行了血液动力学优化,但在败血性休克中出现不良结果的风险更高,这有助于进一步管理.
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