外周灌注指数联合血浆容量对感染性休克患者预后的评估价值

doi:10.11958/20252220

天津医药 ›› 2026, Vol. 54 ›› Issue (2): 169-172.doi: 10.11958/20252220

外周灌注指数联合血浆容量对感染性休克患者预后的评估价值

余优佳(), 秦夏()

张家港市第一人民医院重症医学科（邮编215600）

收稿日期:2025-06-06 修回日期:2025-10-20 出版日期:2026-02-15 发布日期:2026-02-12
通讯作者: 秦夏 E-mail:yanyj188qh@163.com;112072197@qq.com
作者简介:余优佳（1990），男，主治医师，主要从事感染性休克患者临床治疗方面研究。E-mail：yanyj188qh@163.com
基金资助:
张家港市科技计划项目(ZKS2148)

Prognostic value of peripheral perfusion index combined with plasma volume in patients with septic shock

YU Youjia(), QIN Xia()

Department of Critical Care Medicine, the First People's Hospital of Zhangjiagang, Zhangjiagang 215600, China

Received:2025-06-06 Revised:2025-10-20 Published:2026-02-15 Online:2026-02-12
Contact: QIN Xia E-mail:yanyj188qh@163.com;112072197@qq.com

余优佳, 秦夏. 外周灌注指数联合血浆容量对感染性休克患者预后的评估价值[J]. 天津医药, 2026, 54(2): 169-172.

YU Youjia, QIN Xia. Prognostic value of peripheral perfusion index combined with plasma volume in patients with septic shock[J]. Tianjin Medical Journal, 2026, 54(2): 169-172.

摘要/Abstract

摘要：

目的探讨外周灌注指数（PPI）联合血浆容量（PV）对感染性休克患者28 d预后的评估价值。方法 150例感染性休克患者，根据28 d生存情况分为死亡组（52例）和存活组（98例）。比较2组一般资料，入院6 h内实验室检查结果，序贯器官衰竭评估（SOFA）评分，急性生理与慢性健康状况（APACHEⅡ）评分，PPI和PV的差异。采用Cox比例风险回归模型分析患者死亡的影响因素，受试者工作特征（ROC）曲线分析PPI、PV对患者死亡的预测价值。利用Kaplan-Meier曲线比较不同水平的PPI和PV患者28 d死亡率。结果与存活组相比，死亡组年龄较大，SOFA评分、APACHE Ⅱ评分、红细胞压积（HCT）升高，PPI、PV降低（均P<0.05）。Cox回归结果显示，高龄（HR=1.033，95%CI：1.011~1.055）、SOFA评分升高（HR=1.186，95%CI：1.050~1.339）、APACHEⅡ评分升高（HR=1.137，95%CI：1.079~1.197）为感染性休克患者28 d死亡的独立危险因素，PPI（HR=0.136，95%CI：0.062~0.296）、PV（HR=0.904，95%CI：0.858~0.951）升高为独立保护因素（均P<0.05）。根据最佳临界值将患者分为高PPI组（≥1.60，78例）和低PPI组（<1.60，72例），高PV组（≥38.5 mL/kg，69例）和低PV组（<38.5 mL/kg，81例），高PPI和高PV组患者28 d累积总生存率分别高于低PPI组和低PV组（均P<0.05）。ROC曲线分析显示，PPI与PV联合预测感染性休克患者28 d死亡的曲线下面积达0.953（95%CI：0.923~0.983），敏感度为88.46%、特异度为88.78%（均P<0.05）。结论 PPI联合PV在预测感染性休克患者预后方面具有重要价值，可为临床治疗决策提供有力依据。

关键词: 休克，脓毒性, 血浆容量, 外周灌注指数, 28 d预后

Abstract:

Objective To evaluate the value of peripheral perfusion index (PPI) combined with plasma volume (PV) in the 28-day prognosis of patients with septic shock. Methods A total of 150 septic shock patients were divided into two groups based on their 28-day survival status: the death group (n=52) and the survival group (n=98). The general information, laboratory test results within 6 hours of admission, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, PPI and PV were compared between the two groups. The Cox proportional hazards regression model was used to analyze the influencing factors of patient mortality, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of PPI and PV for patient mortality. The 28-day mortality rates of patients with PPI and PV at different levels were compared using the Kaplan-Meier curve. Results Compared with the survival group, patients in the death group were significantly older, with increased SOFA score, APACHE Ⅱ scores, hematocrit (HCT), and decreased PPI and PV values (all P<0.05). Cox proportional hazards regression analysis revealed that older age (HR=1.033, 95%CI: 1.011-1.055), elevated SOFA score (HR=1.186, 95%CI: 1.050-1.339) and increased APACHE Ⅱ score (HR=1.137, 95%CI:1.079-1.197) were independent risk factors for 28-day mortality in patients with septic shock. In contrast, PPI (HR=0.136, 95%CI: 0.062-0.296) and PV (HR=0.904, 95%CI: 0.858-0.951) served as independent protective factors against 28-day mortality (all P<0.05). Based on optimal cut-off values, patients were stratified into the high PPI group (≥1.60, n=78), the low PPI group (<1.60, n=72), the high PV group (≥38.5 mL/kg, n=69) and the low PV group (<38.5 mL/kg, n=81). Kaplan-Meier survival analysis demonstrated significantly higher cumulative 28-day survival rates in the high PPI group and the high PV group compared with their respective low-value groups (all P<0.05). ROC curve analysis showed that the combined use of PPI and PV yielded an AUC of 0.953 (95%CI: 0.923-0.983) for predicting 28-day mortality in septic shock patients, with a sensitivity of 88.46% and specificity of 88.78% (all P<0.05). Conclusion The combination of PPI and PV has significant value in predicting the prognosis of patients with septic shock and can provide strong evidence for clinical treatment decision.

Key words: shock, septic, plasma volume, peripheral perfusion index, 28 d prognosis

中图分类号:

R631.4，R364.19

图/表 7

参考文献 19

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组别	n		年龄/岁		男性	BMI/（kg/m²）		高血压史		糖尿病史		MAP/ mmHg		ALT/（U/L）		AST/（U/L）		Cr/（μmol/L）		BUN/（mmol/L）
存活组	98		63.67±10.66		59（60.2）	20.42±1.49		49（50.0）		37（37.8）		68.63±2.47		22.33±1.72		30.98±2.38		98.62±7.09		6.39±2.38
死亡组	52		78.35±12.33		30（57.7）	20.36±1.47		28（53.9）		22（42.3）		68.42±2.33		22.45±1.36		30.55±2.63		98.47±6.77		6.66±2.45
t或χ²			7.597^＊＊		0.089	0.236		0.201		0.295		0.505		0.436		1.015		0.125		0.655
组别		Lac/（mmol/L）		PCT/ （μg/L）			IL-6/ （ng/L）		PT/s		INR		HCT/%		SOFA/分		APACHE Ⅱ/分		PPI		PV/ （mL/kg）
存活组		4.35±1.08		10.56±1.83			118.56±38.52		11.23±1.44		0.95±0.15		33.53±1.12		10.38±2.45		10.40±3.20		1.80±0.25		41.35±4.26
死亡组		4.22±1.26		10.65±1.81			110.36±30.26		11.26±1.25		0.96±0.13		43.48±1.24		15.33±1.72		18.52±3.24		1.40±0.27		35.59±4.22
t		0.662		0.288			1.332		0.127		0.406		49.878^＊＊		12.963^＊＊		14.727^＊＊		9.069^＊＊		7.907^＊＊

组别	n		年龄/岁		男性	BMI/（kg/m²）		高血压史		糖尿病史		MAP/ mmHg		ALT/（U/L）		AST/（U/L）		Cr/（μmol/L）		BUN/（mmol/L）
存活组	98		63.67±10.66		59（60.2）	20.42±1.49		49（50.0）		37（37.8）		68.63±2.47		22.33±1.72		30.98±2.38		98.62±7.09		6.39±2.38
死亡组	52		78.35±12.33		30（57.7）	20.36±1.47		28（53.9）		22（42.3）		68.42±2.33		22.45±1.36		30.55±2.63		98.47±6.77		6.66±2.45
t或χ²			7.597^＊＊		0.089	0.236		0.201		0.295		0.505		0.436		1.015		0.125		0.655
组别		Lac/（mmol/L）		PCT/ （μg/L）			IL-6/ （ng/L）		PT/s		INR		HCT/%		SOFA/分		APACHE Ⅱ/分		PPI		PV/ （mL/kg）
存活组		4.35±1.08		10.56±1.83			118.56±38.52		11.23±1.44		0.95±0.15		33.53±1.12		10.38±2.45		10.40±3.20		1.80±0.25		41.35±4.26
死亡组		4.22±1.26		10.65±1.81			110.36±30.26		11.26±1.25		0.96±0.13		43.48±1.24		15.33±1.72		18.52±3.24		1.40±0.27		35.59±4.22
t		0.662		0.288			1.332		0.127		0.406		49.878^＊＊		12.963^＊＊		14.727^＊＊		9.069^＊＊		7.907^＊＊

指标	β	SE	Wald χ²	P	HR	HR 95%CI
年龄	0.032	0.011	8.725	0.004	1.033	1.011~1.055
SOFA评分	0.170	0.060	7.592	0.005	1.186	1.050~1.339
APACHEⅡ评分	0.128	0.027	23.317	<0.001	1.137	1.079~1.197
PPI	-1.997	0.398	25.187	<0.001	0.136	0.062~0.296
PV	-0.101	0.026	14.890	<0.001	0.904	0.858~0.951

指标	β	SE	Wald χ²	P	HR	HR 95%CI
年龄	0.032	0.011	8.725	0.004	1.033	1.011~1.055
SOFA评分	0.170	0.060	7.592	0.005	1.186	1.050~1.339
APACHEⅡ评分	0.128	0.027	23.317	<0.001	1.137	1.079~1.197
PPI	-1.997	0.398	25.187	<0.001	0.136	0.062~0.296
PV	-0.101	0.026	14.890	<0.001	0.904	0.858~0.951

指标	AUC（95%CI）	最佳截断值	敏感度/ %	特异度/ %	约登指数
年龄	0.833（0.763~0.903）	70岁	75.00	80.61	0.556
SOFA	0.643（0.555~0.731）	10分	90.38	31.63	0.220
APACHEⅡ	0.841（0.777~0.906）	14分	78.85	75.53	0.544
PPI	0.917（0.872~0.963）	1.60	82.31	86.73	0.692
PV	0.843（0.769~0.917）	38.5 mL/kg	69.23	91.84	0.611
PPI+PV	0.953（0.923~0.983）	-	88.46	88.78	0.772

外周灌注指数联合血浆容量对感染性休克患者预后的评估价值

Prognostic value of peripheral perfusion index combined with plasma volume in patients with septic shock

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组别	n	死亡	中位生存时间/d	Log-rank χ²
高PPI组	78	18（23.1）	27（25，27）	28.712^＊＊
低PPI组	72	34（47.2）	17（15，20）	28.712^＊＊
高PV组	69	17（24.6）	—	7.545^＊＊
低PV组	81	35（43.2）	20（18，23）	7.545^＊＊

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