Prognostic effect of ultra-early use of norepinephrine in elderly patients with infection and hypotension
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摘要: 目的 探讨去甲肾上腺素(norepinephrine，NE)超早期使用对感染伴低血压的老年患者的预后影响。方法 收集2020年1月—2023年1月ICU收治的感染伴低血压的老年患者，比较超早期(液体复苏的伊始)NE使用组与早期(开始液体复苏后0.5~1.0 h)NE使用组24 h乳酸清除率(lactic acid clearance，LCR)、24 h尿量的差异；以早期NE使用为参照，Cox比例风险分析超早期NE使用对28 d死亡率的影响。结果 超早期NE使用组与早期NE使用组LCR、尿量差异无统计学意义(P＞0.05)。当LCR＜3.5 mmol/L时，超早期NE使用组LCR升高(P＜0.05)，两组间尿量差异无统计学意义(P＞0.05)。当LCR≥3.5 mmol/L时，超早期NE使用组尿量有增加趋势(P=0.05)，两组间LCR差异无统计学意义(P＞0.05)。对28 d死亡率的Cox比例风险分析，两组间差异无统计学意义(P＞0.05)。结论 NE超早期使用对感染伴低血压的老年患者的预后无劣性影响。Abstract: Objective To investigate the effect of ultra-early use of norepinephrine(NE) on the prognosis of elderly patients with infection and hypotension.Methods Elderly patients with infection and hypotension admitted to ICU from January 2020 to January 2023 were collected, and the differences of 24 h lactic acid clearance(LCR) and 24 h urine volume were compared between the ultra-early(at the beginning of fluid resuscitation) NE group and the early(0.5-1.0 h after starting fluid resuscitation) NE group. Using early NE use as reference, Cox proportional risk analysis was conducted to analyze the effect of ultra-early NE use on 28-day mortality.Results There was no significant difference in LCR and urine volume between the ultra-early NE use group and the early NE use group. When LCR < 3.5 mmol/L, LCR was increased in the ultra-early NE use group(P < 0.05), and there was no significant difference in urine volume between the two groups. When LCR≥3.5 mmol/L, the urine volume of the ultra-early NE use group tended to increase(P=0.05), and there was no significant difference in LCR between the two groups. Cox proportional risk analysis of 28-day mortality showed no significant difference between the two groups.Conclusion The early use of NE has no adverse effect on the prognosis of infected elderly patients with hypotension.
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Key words:
- infection /
- hypotension /
- elderly /
- norepinephrine
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表 1 超早期NE使用组与早期NE使用组的基线资料比较
X±S 资料 超早期NE使用(28例) 早期NE使用(78例) t/χ2 P 性别/例(%) 1.363 ＞0.05 男 21(75.0) 49(62.8) 女 7(25.0) 29(37.2) 年龄/例(%) 75.63±6.32 79.96±7.20 -2.177 ＜0.05 高血压病/例(%) 8(28.6) 32(41.0) 1.360 ＞0.05 CCI/分 3.43±1.86 4.63±2.75 -1.870 ＞0.05 肺源性感染灶/例(%) 23(82.1) 62(79.5) 0.091 ＞0.05 SOFA/分 6.90±2.78 7.34±2.46 -1.459 ＞0.05 胆红素/(μmol/L) 13.10±9.22 18.21±17.43 -1.688 ＞0.05 肌酐/(μmol/L) 144.76±102.59 153.26±108.11 -0.320 ＞0.05 SI 1.39±0.31 1.38±0.43 0.115 ＞0.05 DSI 2.48±0.70 2.34±0.81 0.718 ＞0.05 MSI 1.96±0.49 1.90±0.63 0.386 ＞0.05 NEWS/分 12.45±2.56 13.38±3.10 -1.259 ＞0.05 Lac/(mmol/L) 3.51±2.71 5.83±4.79 -2.778 ＜0.05 NLR 17.89±12.36 19.82±15.44 -0.519 ＞0.05 PLR 246.92±153.25 308.14±248.37 -1.061 ＞0.05 PCT/(ng/mL) 9.66±13.24 12.85±19.21 -0.768 ＞0.05 
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表 2 超早期NE使用组与早期NE使用组的次要结局比较
X±S 项目 例数 超早期NE使用组 例数 早期NE使用组 P 总体 LCR/% 28 15.51±43.80 78 0.09±72.68 ＞0.05 尿量/mL 1 585.71±1 017.95 1 423.85±1 164.36 ＞0.05 Lac＜3.5 mmol/L LCR/% 16 4.55±45.80 36 -43.79±79.47 ＜0.05 尿量/mL 1 608.33±1 180.18 2 033.04±1 222.97 ＞0.05 Lac≥3.5 mmol/L LCR/% 12 31.33±37.58 42 34.95±42.43 ＞0.05 尿量/mL 1 555.56±820.75 922.18±841.51 =0.05
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表 3 28 d死亡组与幸存组的基线资料比较
X±S 资料 死亡组(78例) 幸存组(28例) t/χ2 P 男/例(%) 49(62.8) 21(75.0) 1.363 ＞0.05 年龄/岁 74.94±11.01 76.48±11.69 -0.546 ＞0.05 高血压病/例(%) 29(37.2) 11(39.3) 0.039 ＞0.05 CCI/分 4.42±2.64 4.09±2.52 0.507 ＞0.05 肺源性感染灶/例(%) 64(82.1) 21(75.0) 0.645 ＞0.05 SOFA/分 7.61±2.28 5.87±2.80 2.340 ＜0.05 胆红素/(μmol/L) 18.87±17.76 11.78±7.34 2.554 ＜0.05 肌酐/(μmol/L) 154.69±113.61 140.22±81.84 0.537 ＞0.05 SI 1.41±0.41 1.30±0.38 1.117 ＞0.05 DSI 2.40±0.78 2.29±0.81 0.545 ＞0.05 MSI 1.94±0.58 1.86±0.64 0.534 ＞0.05 NEWS/分 13.32±2.78 12.64±3.51 0.922 ＞0.05 Lac/(mmol/L) 5.66±4.58 4.02±3.92 1.499 ＞0.05 NLR 19.44±14.46 19.02±15.60 0.115 ＞0.05 PLR 281.85±223.63 322.59±245.34 -0.714 ＞0.05 PCT/(ng/mL) 12.31±19.59 10.81±12.09 0.281 ＞0.05
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表 4 Cox比例风险多因素分析
因素 回归系数 标准误 Wald P OR SOFA 0.086 0.078 1.203 0.273 1.089 胆红素 0.007 0.008 0.746 0.388 1.007 超早期NE使用 -0.216 0.504 0.183 0.668 0.806
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