本文選題：膿毒癥 + 收縮壓血壓變異率�。� 參考：《天津醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的：觀察膿毒癥患者血壓變異率的變化特征,研究其與膿毒癥患者疾病危重程度關(guān)系；觀察膿毒癥患者血壓變異率和內(nèi)分泌、炎癥指標(TNF-α、IL-10、 PCT)的相關(guān)性,探討其可能機制。 方法：選取2011年11月--2012年4月期間入住天津醫(yī)科大學(xué)總醫(yī)院急救中心膿毒癥患者89例,記錄患者入院24小時內(nèi)的一般臨床指標、生命體征、血常規(guī)、肝功能、腎功能、PCT、電解質(zhì)、血氣分析、CRF、ESR、COR、ACTH、游離甲功,收集最差臨床指標計算膿毒癥患者APACHE-II評分；入院48小時內(nèi)進行24小時動態(tài)血壓監(jiān)測。依據(jù)APACHE-II評分將膿毒癥患者分為APACHE II評分19組和APACHE II評分≤19組,比較兩組一般臨床指標、實驗室檢查和24-hours SBP.24-hours DBP、SBPV、DBPV、PP、Dipper百分比。應(yīng)用Spearman相關(guān)性檢驗分析BPV和炎癥指標相關(guān)性。依據(jù)住院死亡率將膿毒癥患者分為存活組和死亡組,根據(jù)膿毒癥患者預(yù)后進行單因素分析,針對單因素分析有意義的指標,進行多因素Logistic回歸分析,分析影響膿毒癥患者預(yù)后的獨立危險因素,繪制受試者工作特征曲線(ROC),并計算曲線下面積,分析判斷膿毒癥患者預(yù)后指標的價值。所有資料均由SPSS17.0統(tǒng)計軟件進行數(shù)據(jù)處理,以p0.05為差異有統(tǒng)計學(xué)意義。 結(jié)果：1APACHE II19膿毒癥患者,SBPV、DBPV、非勺型百分比.COR. LAC、PLT和GLU較APACHE Ⅱ19患者明顯增高(P0.05); PCT、WBC、 Cr、PaO2、CRP、ACTH和TNF-a無顯著差異(P0.05)。 2相關(guān)性分析表明,SBPV、DBPV與APACHEⅡ評分顯著相關(guān)(r=0.732,P0.01; r=0.762, p0.01), SBPV、DBPV與COR具有相關(guān)性(p=0.018,r=0.318；p=0.008,r==0.353),與TNF-α、IL-10.PCT無明顯相關(guān)性(P0.05)。 3Logistic回歸分析顯示,SBPV、DBPV、APACHEⅡ評分和LAC是患者預(yù)后的獨立危險因素。ROC分析顯示,DBPV、SBPV、APAHEⅡ評分和LAC曲線下面積分別為0.890、0.746、0.831和0.915. 結(jié)論：1膿毒癥患者SBPV、DBPV和非勺型百分比增高；2DBPV和SBPV可作為判斷膿毒癥患者預(yù)后的獨立危險因素；3.膿毒癥患者DBPV和SBPV與炎癥指標無關(guān)。
[Abstract]:Objective: to observe the changes of blood pressure variation rate in sepsis patients and its relationship with the critical degree of sepsis, to observe the relationship between blood pressure variation rate and endocrine, inflammatory index TNF- 偽 IL-10, and to explore its possible mechanism. Methods: from November 2011 to April 2012, 89 patients with sepsis in emergency center of Tianjin Medical University General Hospital were selected. The general clinical indexes, vital signs, blood routine examination, liver function, renal function and PCT, electrolyte were recorded within 24 hours after admission. The APACHE-II score of sepsis patients was calculated by collecting the worst clinical indexes and the ambulatory blood pressure was monitored within 48 hours after admission. According to APACHE-II score, sepsis patients were divided into APACHE II score group (19) and APACHE II score 鈮，

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