重症监护室老年慢性阻塞性肺疾病合并呼吸衰竭患者电解质、血乳酸和SII指数变化及与预后的关系

Changes of electrolytes, blood lactic acid, and SII in elderly patients with COPD and respiratory failure in the ICU and their relationship with the prognosis

摘要:

目的 探讨重症监护室老年慢性阻塞性肺疾病（COPD）合并呼吸衰竭患者电解质、血乳酸和全身免疫炎症指数（SII）变化及与预后的关系。方法 回顾性分析2020年4月—2024年4月于金华市中医医院重症监护室收治的85例COPD合并呼吸衰竭患者的临床资料，作为观察组。另收集同期该院收治的32例老年COPD患者为对照组。比较观察组和对照组的电解质、血乳酸与SII水平。根据观察组患者治疗28 d的预后情况分为存活组与死亡组，比较存活组与死亡组的一般临床资料与电解质、血乳酸、SII水平，采用多因素一般Logistic回归模型分析预后不良的影响因素。结果 观察组钠（Na）、钾（K）水平均低于对照组，血乳酸、SII水平均高于对照组（P <0.05）。治疗28 d后，63例患者存活纳入存活组，余下22例纳入死亡组。存活组与死亡组Na、K、血乳酸及SII水平比较，差异均有统计学意义（P <0.05）。多因素一般Logistic回归分析结果显示，Na ［O^R =1.499（95% CI：1.079，2.084）］、K ［O^R =1.670（95% CI：1.041，2.679）］、血乳酸［O^R =4.865（95% CI：1.136，20.828）］及SII ［O^R =9.845（95% CI：1.131，85.699）］均为老年COPD合并呼吸衰竭患者死亡的危险因素（P <0.05）。结论 重症监护室老年COPD合并呼吸衰竭患者的电解质、血乳酸与SII指数会发生明显变化，Na、K、血乳酸及SII均为老年COPD合并呼吸衰竭患者死亡的危险因素。

Abstract:

Objective To investigate the changes of electrolytes, blood lactic acid, and systemic immune-inflammation index (SII) in elderly patients with chronic obstructive pulmonary disease (COPD) and respiratory failure in the intensive care unit (ICU), and their relationship with the prognosis.Methods The clinical data of patients with COPD and respiratory failure (observation group) treated in the ICU from April 2020 to April 2024 were analyzed retrospectively. Meanwhile, 32 elderly patients with COPD treated in the hospital were selected as the control group. Electrolytes, blood lactic acid and SII were compared between the two groups. According to the 28-day prognosis, patients in the observation group were divided into survival group and death group. General clinical data, electrolytes, blood lactic acid levels and SII of the two groups were compared. The influencing factors of poor prognosis were analyzed.Results The levels of natrium (Na) and kalium (K) in the observation group were lower than those in the control group, and the levels of blood lactic acid and SII were higher than those in the control group (P <0.05). After 28 d of treatment, 63 out of 85 patients survived and were included in the survival group. The remaining 22 patients were included in the death group. There were statistically significant differences in the levels of Na, K, blood lactic acid and SII between the survival group and the death group (P < 0.05). Multivariate logistic regression analysis results showed that Na [O^R =1.499 (95% CI: 1.079, 2.084)], K [O^R =1.670 (95% CI: 1.041, 2.679)], blood lactic acid [O^R =4.865 (95% CI: 1.136, 20.828)], and SII [O^R =9.845 (95% CI: 1.131, 85.699)] were risk factors for death in elderly patients with COPD and respiratory failure (P <0.05).Conclusion There are significant changes of electrolytes, blood lactic acid and SII in elderly patients with COPD and respiratory failure in the ICU. Na, K, blood lactic acid and SII were risk factors for death in elderly patients with COPD and respiratory failure.