血氨对脓毒症患者病情严重程度的评估及预后的预测价值

The Predictive Value of Blood Ammonia in Assessing the Severity and Prognosis of Sepsis Patients

摘要: 目的：探讨动脉血氨对于脓毒症患者疾病严重程度评估及预后预测方面的价值。方法：选择2019年01月至2020年01月在济宁市第一人民医院重症监护病房住院的145例成人脓毒症患者，根据脓毒症诊断标准分为脓毒症休克组(n = 48)和脓毒症组(n = 97)，根据28 d生存情况分为存活组(n = 89)和死亡组(n = 56)，分别比较两组动脉血氨水平及其他临床指标的差异，使用受试者工作特征曲线(ROC)对动脉血氨及其他各指标与脓毒症患者存在情况进行分析。结果：脓毒性休克组患者心率、白细胞计数、降钙素原(PCT)、超敏C反应蛋白(CRP)、乳酸、脓毒症相关序贯器官衰竭(SOFA)评分、急性生理与慢性健康(APACHEII)评分、血氨及28 d病死率均高于脓毒症组，舒张压和收缩压均低于脓毒症组，有统计学差异(P < 0.05)。死亡组收缩压、舒张压均较存活组低，死亡组白细胞计数、CRP、PCT、乳酸、APACHEII评分、SOFA评分、血氨均高于存活组，差异均有统计学意义(P < 0.05)。ROC曲线分析结果显示：血氨、乳酸、PCT、CRP、SOFA评分、APACHEII评分对脓毒症患者28 d预后均有预测价值，其中血氨的曲线下面积(AUC)为0.782。血氨分别与SOFA评分、APACHEII评分、乳酸评分联合诊断的AUC分别为0.831、0.821、0.798，血氨联合其他指标相较于单用血氨对预后的判断效能更高。结论：动脉血氨在脓毒症患者疾病严重程度评估和预后的预测方面具有较好的应用价值。

Abstract: Objective: This paper aims to investigate the value of arterial blood ammonia in assessing the severity of sepsis and predicting prognosis in adult sepsis patients. Method: 145 adult sepsis patients admitted to the intensive care unit of Jining No.1 People’s Hospital from January 2019 to January 2020 were selected and divided into septic shock group (n = 48) and sepsis group (n = 97) according to the criteria for sepsis. The patients were divided into survival group (n = 89) and death group (n = 56) according to their survival status within 28 days. The differences in arterial blood ammonia levels and other clinical indicators between the two groups were compared, and the receiver operating characteristic (ROC) curve was used to analyze the relationship between arterial blood ammonia and the presence of sepsis in patients. Result: Heart rate, white blood cell count, procalcitonin (PCT), hypersensitive C-reactive protein (CRP), lactic acid, sepsis related sequential organ failure (SOFA) score, acute physiological and chronic health (APACHEII) score, blood ammonia and 28d mortality in septic shock group were higher than those in sepsis group, while diastolic blood pressure and systolic blood pressure were lower than those in sepsis group. There was statistical difference (P < 0.05). The systolic blood pressure and diastolic blood pressure of the death group were lower than those of the survival group, and the white blood cell count, CRP, PCT, lactic acid, APACHEII score, SOFA score and blood ammonia of the death group were higher than those of the survival group, with statistical significance (P < 0.05). ROC curve analysis results showed that blood ammonia, lactic acid, PCT, CRP, SOFA score and APACHEII score all had predictive value for 28d prognosis of sepsis patients, and the area under the curve (AUC) of blood ammonia was 0.782. The AUC of blood ammonia combined with SOFA score, APACHEII score and lactic acid score were 0.831, 0.821 and 0.798, respectively. Blood ammonia combined with other indexes had higher prognostic efficacy than blood ammonia alone. Conclusion: Arterial ammonia has good application value in evaluating the disease severity and predicting the prognosis of sepsis patients.