成年ICU患者反勺型血压变异对医院病死率的影响

doi:10.3969/j.issn.1002-1949.2019.03.002

摘要
图/表
参考文献(24)
相关文章 (2)

全文: PDF (657 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨成年重症监护室（ICU）患者非勺型及反勺型血压变异对医院病死率的影响。方法采用回顾性队列研究，纳入单次收住ICU且ICU住院时长>24 h的勺型、非勺型及反勺型血压变异成年患者。并提取患者的年龄、性别、种族、首次序贯器官衰竭评分（SOFA评分）、首次简化急性生理评分（SAPS-Ⅰ评分）、服用血管活性药物、镇静药情况以及患病情况等。将患者是否于医院死亡及血压变异类型分别作为因变量和自变量纳入Logistic回归模型，并在不同SOFA评分患者中进行亚组分析。结果本研究共纳入患者8306例，其中勺型血压变异患者1285例（15.5%），非勺型血压变异患者3608例（43.4%），反勺型血压变异患者3413例（41.1%），医院病死率在三组分别为13.0%、12.1% 及15.8%。反勺型血压变异患者的医院病死率是勺型血压患者的1.258倍（95%CI 1.015~1.558）。在4874例SOFA评分≤8的患者中，反勺型血压变异患者的医院病死率是勺型血压变异患者的1.691倍（95%CI 1.218~2.347）。结论反勺型血压变异可能是ICU患者医院死亡的危险因素之一，在病情相对较轻的患者中危险度更高。 

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	李佳媚
	赵玉杰
	张小玲
	高雅
	张静静
	李若寒
	王利
	王小闯
	王岗

关键词 ：重症监护室(ICU), 血压变异, 勺型, 医院病死率

基金资助:国家自然科学基金（81670049, 81770057）;陕西省重点研发计划项目（2017SF-059）

通讯作者: 王岗（1982-），男，博士，教授，博士生导师，重症医学科副主任，E-mail：gang_wang@xjtu.edu.cn。

作者简介: 李佳媚（1991-），女，硕士，实习研究员，E-mail：18792478857@163.com。

引用本文:

李佳媚,赵玉杰,张小玲,高雅,张静静,李若寒,王利,王小闯,王岗. 成年ICU患者反勺型血压变异对医院病死率的影响[J]. 中国急救医学, 2019, 39(3): 206-210.
Li Jia-mei, Zhao Yu-jie, Zhang Xiao-ling, Gao Ya, Zhang Jing-jing, Li Ruo-han, Wang Li, Wang Xiao-chuang, Wang Gang. The association between reverse-dipper blood pressure pattern and hospital mortality in adult critically ill patients. Chinese Journal of Critical Care Medicine, 2019, 39(3): 206-210.

链接本文:

http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.03.002 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I3/206

［1］Freedman NS, Gazendam J, Levan L, et al. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit［J］. Am J Respir Crit Care Med, 2001, 163(2):451-457. ［2］Gazendam JA, Van Dongen HP, Grant DA, et al. Altered circadian rhythmicity in patients in the ICU［J］. Chest, 2013, 144(2):483-489. ［3］Fagard RH, Celis H, Thijs L, et al. Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension［J］. Hypertension, 2008, 51(1):55-61. ［4］李慧妍，刘越. 血压变异性与靶器官损害关系的研究进展［J］. 中国急救医学, 2016, 36(8):758-762. ［5］Yan B, Sun L, Gao Y, et al. Blood pressure reverse dipping may associate with stable coronary artery disease in patients with essential hypertension: a cross-sectional study［J］. Sci Rep,2016, 6:25 410. ［6］Yan B, Yan H, Sun L,et al. Novel association between the reverse-dipper pattern of ambulatory blood pressure monitoring and metabolic syndrome in men but not in women［J］. Medicine (Baltimore), 2015, 94(47):e2115. ［7］Sun L, Yan B, Gao Y, et al. Relationship between blood pressure reverse dipping and type 2 diabetes in hypertensive patients［J］. Sci Rep, 2016, 6:25 053. ［8］Yan B, Peng L, Han D,et al. Blood pressure reverse-dipping is associated with early formation of carotid plaque in senior hypertensive patients［J］. Medicine (Baltimore), 2015, 94(10):e604. ［9］Yan B, Peng L, Dong Q, et al. Reverse-dipper pattern of blood pressure may predict lacunar infarction in patients with essential hypertension［J］. Eur J Neurol, 2015, 22(6):1022-1025. ［10］Saeed M, Villarroel M, Reisner AT, et al. Multiparameter Intelligent Monitoring in Intensive Care Ⅱ: a public-access intensive care unit database［J］. Crit Care Med, 2011, 39(5):952-960. ［11］Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit［J］. JAMA, 2017, 317(3):290-300. ［12］张越新, 张玲, 郭贤庆. PCT CRP 血乳酸 APACHEⅡ SOFA评分在脓毒症患者疾病严重程度及预后评估中的价值研究［J］. 中国急救医学, 2017, 37(12):1109-1114. ［13］Ridley SA. Critical care outcomes［J］. Anaesthesia, 2010, 56(1):1-3. ［14］Fagard RH. Dipping pattern of nocturnal blood pressure in patients with hypertension［J］. Expert Rev Cardiovasc Ther， 2009, 7(6):599-605. ［15］Weiss A, Beloosesky Y, Koren-Morag N,et al. Association between mortality and blood pressure variability in hypertensive and normotensive elders: A cohort study［J］. J Clin Hypertens (Greenwich), 2017, 19(8):753-756. ［16］Tang Y, Sorenson J, Lanspa M, et al. Systolic blood pressure variability in patients with early severe sepsis or septic shock: a prospective cohort study［J］. BMC Anesthesiol, 2017, 17(1):82. ［17］Xie Z, Liao X, Yin W, et al. Relationship between short-term blood pressure variability and incidence of acute kidney injury in critically ill patients［J］. Kidney Blood Press Res, 2017, 42(6):1238-1246. ［18］Fukushima H, Kobayashi M, Kawano K, et al. SOFA and quick SOFA are more clinically useful scoring systems than SIRS inpredicting mortality of patients with acute pyelonephritis associated with upper urinary tract calculi［J］. European Urology Supplements, 2018, 17(2):e458. ［19］Fabbian F, Smolensky MH, Tiseo R， et al. Dipper and non-dipper blood pressure 24-hour patterns: circadian rhythm-dependent physiologic and pathophysiologic mechanisms［J］. Chronobiol Int， 2013, 30(1-2):17-30. ［20］Boldt J, Menges T, Kuhn D, et al. Alterations in circulating vasoactive substances in the critically ill-a comparison between survivors and non-survivors［J］. Intensive Care Med， 1995, 21(3):218-225. ［21］Müller B. Endocrine aspects of critical illness［J］. Ann Endocrinol (Paris)， 2007, 68(4):290-298. ［22］才旦多杰, 耿智华贞. ICU多发性创伤患者神经内分泌的动态变化研究［J］. 中国急救医学, 2016， 36(12):1093-1098. ［23］Van den Berghe G. Endocrine changes in critically ill patients［J］. Growth Horm IGF Res， 1999, 9:77-81.［24］Takala J, Ruokonen E, Webster NR， et al. Increased mortality associated with growth hormone treatment in critically ill adults［J］. N Engl J Med，1999, 341(11):785-792.