摘要
目的探讨孕产妇发生脓毒性休克的危险因素。方法回顾性分析2013年1月至2025年4月收治的122例产科脓毒症患者的临床资料,根据是否进展为脓毒性休克将患者分为休克组(26例)和非休克组(96例),记录两组患者的年龄、BMI、是否多胎妊娠、脓毒症相关序贯器官衰竭评估(SOFA)评分、器官功能障碍情况、白细胞计数、中性粒细胞计数、中性粒细胞比例、血小板计数以及降钙素原、CRP、乳酸、D-二聚体水平。采用多因素logistic回归分析确定产科脓毒性休克发生的独立危险因素,通过ROC曲线评估相关危险因素对脓毒性休克发生的预测效能。结果休克组患者中年龄≥35岁及存在呼吸功能障碍、心功能障碍、中枢神经系统功能障碍的患者比例高于非休克组,SOFA评分、白细胞计数、中性粒细胞计数、中性粒细胞比例、乳酸水平高于非休克组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果表明,中性粒细胞计数升高(OR=1.093,95%CI 1.022~1.169,P=0.010)和年龄≥35岁(OR=3.433,95%CI 1.112~10.602,P=0.032)是产科脓毒性休克发生的独立危险因素。ROC曲线显示,中性粒细胞计数对产科脓毒性休克的发生有预测价值(AUC=0.741,95%CI 0.634~0.848),最佳截断值为17.17×10~9/L。结论中性粒细胞计数升高和年龄≥35岁为产科脓毒性休克发生的独立危险因素,中性粒细胞计数对产科脓毒性休克的发生具有一定的预测价值,可为临床病情评估和及时治疗提供依据。
Objective To explore the risk factors for obstetric septic shock.Methods The clinical data of 122 obstetric sepsis patients from Jan.2013 to Apr.2025 were retrospectively analyzed.The patients were assigned to shock group(n=26)or non-shock group(n=96)based on whether they progressed to septic shock.Variables including age,body mass index,multiple pregnancy,sequential organ failure assessment(SOFA)score,organ dysfunction status,white blood cell count(WBC),neutrophil count(NEU),neutrophil ratio,platelet count,procalcitonin,C-reactive protein,lactate(Lac),and D-dimer were recorded.Multivariate logistic regression analysis was used to identify the independent risk factors for obstetric septic shock.The predictive efficacy of these factors was evaluated using receiver operating characteristic(ROC)curve analysis.Results The proportions of patients aged≥35 years,and those with respiratory,cardiac,or central nervous system dysfunction,were significantly higher in the shock group than in the non-shock group,and the SOFA score,WBC,NEU,neutrophil ratio and Lac level were significantly higher in the shock group(all P<0.05).Multivariate logistic regression analysis showed that increased NEU(odds ratio[OR]=1.093,95%confidence interval[CI]1.022-1.169,P=0.010)and age≥35 years(OR=3.433,95%CI 1.112-10.602,P=0.032)were independent risk factors for obstetric septic shock.ROC curve analysis showed that NEU had predictive value for obstetric septic shock(area under curve=0.741,95%CI 0.634-0.848),with an optimal cut-off value of 17.17×109/L.Conclusion Increased NEU and age≥35 years are independent risk factors for obstetric septic shock.NEU has predictive value for the development of obstetric septic shock and may serve as an important indicator for clinical assessment and timely treatment.
作者
谭美玲
胡雪源
熊逸清
郑明昱
阎萍
王丹
TAN Meiling;HU Xueyuan;XIONG Yiqing;ZHENG Mingyu;YAN Ping;WANG Dan(Department of Obstetrics and Gynecology,The First Affiliated Hospital of Army Medical University(Third Military Medical University),Chongqing 400038,China;Sichuan Women and Children’s Hospital,Chengdu 610045,Sichuan,China;Department of Pharmacy,The First Affiliated Hospital of Army Medical University(Third Military Medical University),Chongqing 400038,China)
出处
《海军军医大学学报》
北大核心
2025年第11期1496-1501,共6页
Academic Journal of Naval Medical University
基金
重庆市技术创新与应用发展专项重点项目(CSTB2022TIAD-KPX0173)。
关键词
脓毒症
孕产妇
脓毒性休克
危险因素
中性粒细胞
sepsis
pregnant and postpartum women
septic shock
risk factors
neutrophils
