血液系统恶性肿瘤粒细胞缺乏期感染患者生命体征预测价值的研究

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目的:探讨血液系统恶性肿瘤化疗后粒细胞缺乏期并发感染患者死亡及实施应急处置前的生命体征变化情况,分析不同生命体征对患者预后及实施应急处置的预测效能。方法:采用病例对照的研究方法,选取符合纳入标准的211例血液系统恶性肿瘤患者为研究对象,收集患者的生命体征,应用SPSS17.0软件分析生命体征在预后及应急处置分组中的统计学意义及预测价值。结果:心率、呼吸频率、收缩压、血氧饱和度及尿量在存活组(112例)与死亡组(99例)间的比较差异有统计学意义(n t值为11.038~177.102,n P<0.01),其中体温、心率、呼吸频率、收缩压、血氧饱和度及尿量的受试者工作特征曲线下面积分别为0.547、0.495、0.294、0.899、0.988、0.827,以血氧饱和度变化的预测效能最高(高等水平),其对应的最佳截断点为0.91;在应急处置组(103例)与非应急处置组(108例)之间,心率、呼吸频率及血氧饱和度在2组间的比较差异有统计学意义(n t值为5.247、8.001、9.066,n P<0.01),体温、心率、呼吸频率、收缩压、血氧饱和度及尿量的受试者工作特征曲线下面积分别为0.581、0.732、0.813、0.346、0.102、0.543,其中以呼吸频率变化的预测价值最高(中等水平),其对应的最佳截断点为27.5。n 结论:不同生命体征对血液系统恶性肿瘤化疗后粒细胞缺乏期感染患者病情变化预测的效能不同,当呼吸频率超过27次/min时提示患者需实施抢救等应急处置的概率将增加,若病情未得到有效控制,血氧饱和度<0.91时,患者死亡风险大大增加。“,”Objective:To investigate the death of patients with granulocytopenia complicated with infection after chemotherapy and the changes of vital signs before emergency treatment, and to analyze the prognosis of different vital signs on patients' prognosis and emergency treatment.Methods:This study used a case-control study method to select 211 patients with hematologic malignancies who met the inclusion criteria in two tertiary hospitals in Weifang City. The vital signs of patients were collected and the vital signs were analyzed using SPSS 17.0 software. And the statistical significance and predictive value in the emergency response group.Results:The heart rate, respiratory rate, systolic blood pressure, blood oxygen saturation and urine volume were significantly different between the survival group (112 cases) and the death group (99 cases)(n t values were 11.038-177.102, n P<0.01). The area under the receiver operating characteristic curve of body temperature, heart rate, respiratory rate, systolic blood pressure, and blood oxygenation saturation and urine volume were 0.547, 0.495, 0.294, 0.899, 0.988, and 0.827, respectively. The highest predictive efficiency (higher level) was observed with the change of blood oxygen saturation, and the corresponding optimal cutoff point. 0.91; between the emergency treatment group (103 cases) and the non-emergency treatment group(108 cases), the difference in heart rate, respiratory rate and oxygen saturation between the two groups was statistically significant (n t values were 5.247, 8.001, 9.066, n P<0.01). The area under the receiver operating characteristic curve of body temperature, heart rate, respiratory rate, systolic blood pressure, blood oxygen saturation and urine volume were 0.581, 0.732, 0.813, 0.346, 0.102, and 0.543, respectively. Among them, the predicted value of respiratory frequency change was the highest (medium level), which was the best corresponding. The cutoff point was 27.5.n Conclusions:Patients with granulocytic infection after malignant hematologic disease will have abnormal changes in vital signs before death and emergency treatment. However, different vital signs have different effects on predicting disease changes, and should focus on respiratory rate and oxygen saturation. Changes, when the respiratory rate exceeds 27 beats/min, the probability that the patient needs to implement emergency treatment such as rescue will increase. If the condition is not effectively controlled, the blood oxygen saturation is lower than 0.91, the risk of death of the patient is greatly increased.
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