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脓毒症患者发生重症监护病房获得性肌无力的危险因素:一项对264例患者的回顾性研究。

Risk factors for ICU-acquired weakness in sepsis patients: A retrospective study of 264 patients.

作者信息

Liu Jiajiao, Xu Zhaoxia, Luo Shuhong, Bai Yujie, Feng Jian, Li Fuxiang

机构信息

Department of Critical Care Medicine, The General Hospital of Western Theater Command PLA, Chengdu, 610036, China.

Department of Emergency Department, The General Hospital of Western Theater Command PLA, Chengdu, 610036, China.

出版信息

Heliyon. 2024 May 31;10(11):e32253. doi: 10.1016/j.heliyon.2024.e32253. eCollection 2024 Jun 15.

Abstract

BACKGROUND

Sepsis is a common critical illness in intensive care unit (ICU) and an important risk factor for intensive care unit-acquired weakness (ICU-AW). The objective of the study is to analyze the risk factors of ICU-AW in septic patients.

METHODS

A total of 264 septic patients admitted to the General Hospital of the Western Theater Command from January 2018 to April 2022 were included in this study. The cohort was divided into 2 groups according to the presence or absence of ICU-AW. Clinical characteristics included age, sex, body mass index, length of ICU stay, multiple organ dysfunction syndrome, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), mechanical ventilation time, intubation, tracheotomy, protective constraint, lactic acid, fasting blood glucose, etc. The clinical characteristics of sepsis were evaluated using logistic regression analysis.

RESULTS

A total of 114 septic patients suffered ICU-AW during their ICU stay. Multivariate binary logistic regression analysis showed that APACHE Ⅱ score, mechanical ventilation time, protective constraint, and lactic acid were independent risk factors for ICU-AW in septic patients. The areas under the receiver operating characteristic curve (AUCs) were 0.791, 0.740 and 0.812, all P < 0.05, and the optimal cut-off values were 24 points, 5 days and 2.12 mmol/L, respectively.

CONCLUSIONS

A high APACHE Ⅱ score, long mechanical ventilation time, protective constraint and high lactate concentration are independent risk factors for ICU-AW in septic patients. An APACHE Ⅱ score greater than 24 points, mechanical ventilation time longer than 5 days and lactate concentration higher than 2.12 mmol/L are likely to cause ICU-AW.

摘要

背景

脓毒症是重症监护病房(ICU)常见的危重病,也是ICU获得性肌无力(ICU-AW)的重要危险因素。本研究的目的是分析脓毒症患者发生ICU-AW的危险因素。

方法

本研究纳入了2018年1月至2022年4月期间在西部战区总医院收治的264例脓毒症患者。根据是否存在ICU-AW将队列分为两组。临床特征包括年龄、性别、体重指数、ICU住院时间、多器官功能障碍综合征、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)、机械通气时间、插管、气管切开、保护性约束、乳酸、空腹血糖等。采用逻辑回归分析评估脓毒症的临床特征。

结果

共有114例脓毒症患者在ICU住院期间发生了ICU-AW。多因素二元逻辑回归分析显示,APACHEⅡ评分、机械通气时间、保护性约束和乳酸是脓毒症患者发生ICU-AW的独立危险因素。受试者工作特征曲线(AUC)下面积分别为0.791、0.740和0.812,均P<0.05,最佳截断值分别为24分、5天和2.12mmol/L。

结论

高APACHEⅡ评分、长机械通气时间、保护性约束和高乳酸浓度是脓毒症患者发生ICU-AW的独立危险因素。APACHEⅡ评分大于24分、机械通气时间长于5天和乳酸浓度高于2.12mmol/L可能会导致ICU-AW。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f6b2/11168428/9363b318b291/gr1.jpg

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