中国临床药学杂志

目的 探讨头孢哌酮舒巴坦治疗重症感染患者引起凝血异常的相关因素，并建立预测模型。方法 收集医院重症医学科2019年1月至2020年12月62例使用头孢哌酮钠舒巴坦钠患者的相关资料，根据凝血功能结果分为正常组和异常组，采用二元Logistic回归分析，寻找独立危险因素同时根据Logistic模型建立联合预测因子。绘制联合预测因子及单一影响因素的ROC曲线并比较其预测准确性。结果 纳入的62例患者中共14例发生凝血异常，发生率为22.58%。Logistic回归分析显示年龄(OR=1.160,95%CI:1.020～1.319,P=0.024)、C反应蛋白水平(OR=1.095,95%CI:1.020～1.176,P=0.012)、尿素氮水平(OR=1.139,95%CI:1.021～1.270,P=0.019)、进食<1000 m L·d^-1(OR=5.896,95%CI:1.069～32.511,P=0.042)是头孢哌酮钠舒巴坦钠致凝血异常的独立危险因素。年龄越大、C反应蛋白和尿素氮水平越高、进食<1 000 m L·d^-1的患者发生凝血异常的风险越大。联合预测因子ROC曲线下面积为0.891(P <0.01)，约登指数为0.669，均高于其他单一因素。结论 当患者存在高龄、C反应蛋白及尿素氮水平升高、进食<1 000 m L·d^-1的因素时，头孢哌酮钠舒巴坦钠引起凝血功能异常的风险升高。联合预测因子能够较准确地预测凝血异常风险，临床上值得进一步推广。

AIM To explore the related factors of abnormal coagulation induced by cefoperazone sulbactam in patients with severe infection and build a predictive model. METHODS A total of 62 patients treated with cefoperazone sodium and sulbactam sodium from January 2019 to December 2020 were collected. The patients were divided into normal group and abnormal group according to the results of blood coagulation function. Binary logistic regression analysis was used to find independent risk factors and establish combined predictors according to logistic model. ROC curves of combined predictors and single influencing factor were drawn and their prediction accuracy was compared.RESULTS Among 62 patients, 14 patients had coagulation abnormality, and the incidence rate was 22.58%. Logistic regression analysis showed that age(OR = 1.160, 95%CI:1.020-1.319, P = 0.024), C-reactive protein level(OR = 1.095,95%CI:1.020-1.176, P = 0.012), urea nitrogen level(OR = 1.139, 95%CI:1.021-1.270, P = 0.019), the volume of enteral nutrition < 1 000 mL·d^-1(OR = 5.896, 95%CI:1.069-32.511, P = 0.042) were independent risk factors for coagulation abnormality caused by cefoperazone sodium and sulbactam sodium. Patients with older age, higher levels and C-reactive protein and urea nitrogen, and the volume of enteral nutrition less than 1 000 mL·d^-1 had a greater risk of abnormal coagulation. The area under the ROC curve of the combined predictor was 0.891(P < 0.01), and the youden index was 0.669, which was higher than the other single factors. CONCLUSION The risk of coagulation dysfunction caused by cefoperazone sodium and sulbactam sodium will be higher when the patients with older age, higher levels of C-reactive protein and urea nitrogen, or the volume of enteral nutrition less than 1 000 mL·d^-1. Combined predictors can accurately predict the risk of coagulation abnormality, which is worthy of further promotion.