血管活性药物评分在指导脓毒性休克患者实施肠内营养时机的应用

Vasoactive Inotropic Score in Guiding the Timing of Implementation of Enteral Nutrition in Patients with Septic Shock

摘要: 目的：评估血管活性药物评分(vasoactive inotropic score, VIS)预测脓毒性休克患者发生肠内营养不耐受的价值，指导实施肠内营养的时机。方法：为单中心回顾性队列研究，收集2019年1月至2022年12月安徽医科大学附属合肥医院(合肥市第二人民医院)收治的136例脓毒性休克患者的临床资料，根据诊疗过程中肠内营养耐受情况分为耐受组和不耐受组(AGI II级及以上胃肠功能损害)，计算所有患者最初进食肠内营养24 h时最大血管活性药物评分，以VIS max24表示，同时选取机械通气、镇静剂、血乳酸、低蛋白血症、序贯器官衰竭估计评分(Sequential Organ Failure Assessment, SOFA评分)、急性生理与慢性健康评分(APACHE II评分)等为危险因素。采用单因素及多因素Logistic回归分析肠内营养不耐受的独立危险因素，受试者工作特征曲线(ROC)对VIS的预测价值进行分析。结果：耐受组和不耐受组在年龄、性别、钾制剂的使用、抗生素使用种类等差异均无统计学意义(P > 0.05)，不耐受组的VISmax24、SOFA评分、APACHE II评分、血乳酸明显升高。VIS max24可以预测肠内营养不耐受发生率(AUC = 0.942, 95% CI: 0.898~0.987)，截断值为30.35 (灵敏度：0.926，特异度：0.890约登指数：0.816)，较SOFA评分(AUC = 0.888, 95% CI: 0.829~0.947)、APACHE II评分(AUC = 0.876, 95% CI: 0.809~0.943)、血乳酸(AUC = 0.830, 95% CI: 0.758~0.901)预测效能更高。结论：VIS max24能够预测脓毒性休克患者的肠内营养不耐受的发生，评分30.35以下使用肠内营养发生不耐受的可能性小。

Abstract: Objective: To evaluate the value of the vasoactive inotropic score (VIS) in predicting the develop-ment of enteral nutrition intolerance in patients with septic shock. Methods: This experiment was a single-center retrospective cohort study. The clinical data of 136 patients with septic shock who were treated with vasoactive drugs and enteral nutrition in the Hefei Hospital Affiliated to Anhui Medical University (Second People’s Hospital of Hefei) from January 2019 to December 2022 were collected, they were divided into tolerant and intolerant groups (AGI Grade 2 and above gastroin-testinal impairment) according to enteral nutrition tolerance, and the maximum vasoac-tive-inotropic score of all patients at the first 24 h was calculated, which was expressed as VIS max24. Mechanical ventilation, sedation, blood lactate, hypoproteinemia, Sequential Organ Failure Assessment (SOFA score), and Acute Physiology and Chronic Health Score (APACHE II score) were selected as risk factors. Multivariate logistic regression analysis was used to find the independent risk factors that influence the enteral nutrition tolerance. The receiver operating characteristic curve was used to analyze the predictive value of VIS. Results: There were no statistically significant differences between the tolerant and intolerant groups in terms of age, gender, use of potassium preparations, and type of antibiotic use (P > 0.05), VIS max24, SOFA score, APACHE II score, and blood lactate were significantly higher in the intolerant group. VIS max24 could predict the devel-opment of enteral nutrition intolerance (AUC = 0.942, 95% CI: 0.898~0.987), Cut-off value of 30.35 (sensitivity: 0.926, specificity: 0.890 Yoden index: 0.816), which were more efficient compared to SOFA score (AUC = 0.888, 95% CI: 0.829~0.947), APACHE II score (AUC = 0.876, 95% CI: 0.809~0.943), and blood lactic acid (AUC = 0.830, 95% CI: 0.758~0.901). Conclusion: The VIS max24 can predict the development of enteral nutrition intolerance in patients with septic shock and the likelihood of intolerance with enteral nutrition below a score of 30.35 is low.