2023 年第 1 期 第 18 卷

液体复苏前后外周灌注参数水平与脓毒症休克患者并发谵妄的关系

The relationship between the levels of peripheral perfusion parameters before and after liquid resuscitation and concurrent delirium in patients with septic shock

作者：李云婷李芬冯奇桃

英文作者：Li Yunting Li Fen Feng Qitao

单位：海南医学院第二附属医院急诊科，海口570311

英文单位：Department of Emergency the Second Affiliated Hospital of Hainan Medical University Haikou 570311 China

关键词：脓毒症休克；谵妄；外周灌注指数

英文关键词：Septicshock；Delirium；Peripheralperfusionindex

• 摘要：

• 目的  探讨液体复苏前后外周灌注参数水平与脓毒症休克患者并发谵妄的关系。方法 选取2020年1月至2022年6月海南医学院第二附属医院重症监护病房（ICU）收治的脓毒症休克患者223例，依据入ICU后3 d内是否并发谵妄将患者分为谵妄组（102例）和非谵妄组（121例）。采用单因素分析、多因素Logistic回归分析和受试者工作特征（ROC）曲线方法 探讨液体复苏前后外周灌注参数与脓毒症休克患者并发谵妄的关系。结果 多因素Logistic回归分析结果显示，脑血管疾病、序贯器官衰竭估计（SOFA）评分值升高、液体复苏前外周灌注指数（PPI）降低及液体复苏后6 h时 PPI降低是脓毒症休克患者并发谵妄的独立预测因子（均P＜0.05）。ROC曲线分析结果显示，液体复苏后6 h时PPI预测脓毒症休克患者并发谵妄的曲线下面积明显大于液体复苏前PPI和SOFA评分（0.864比0.751、0.750,均P＜0.05）。当液体复苏后6 h PPI为2.12时，预测谵妄的敏感度为74.5%，特异度为95.9%。结论 液体复苏前后PPI可作为脓毒症休克患者并发谵妄的预测因子，液体复苏后6 h时PPI对谵妄的预测效能较好。

• Objective To explore the relationship between peripheral perfusion parameters before and after liquid resuscitation and concurrent delirium in patients with septic shock. Methods From January 2020 to June 2022， totally 223 patients with septic shock were enrolled from Intensive Care Unit(ICU), the Second Affiliated Hospital of Hainan Medical University. Patients were divided into the delirium group(102 cases) and non-delirium group(121 cases) according to whether delirium occurred within 3 d after admission to ICU. Univariate analysis, multivariate Logistic regression analysis and receiver operating characteristic(ROC) curve were used to explore the relationship between peripheral perfusion parameters before and after fluid resuscitation and concurrent delirium in patients with septic shock. Results Multivariate Logistic regression analysis showed that cerebrovascular disease, the elevated value of sequential organ failure assessment(SOFA) score, the decreased value of peripheral perfusion index(PPI) before liquid resuscitation and the decreased value of PPI 6 h after liquid resuscitation were independent predictors for concurrent delirium in patients with septic shock(all P＜0.05). ROC curve analysis showed that the area under ROC curve of PPI 6 h after liquid resuscitation was significantly larger than that of PPI before liquid resuscitation and SOFA score（0.864 vs 0.751, 0.750, both P＜0.05）.When the cut-off value of PPI 6 h after fluid resuscitation was 2.12， the sensitivity and specificity to predict delirium were 74.5% and 95.9%, respectively. Conclusion PPI before and after liquid resuscitation can be used as an independent predictor for concurrent delirium in patients with septic shock, and the predictive efficiency of PPI 6 h after fluid resuscitation is good.