脓毒血症病例329例临床特征及治疗情况分析

发布时间：2018-01-05 05:13

  本文关键词：脓毒血症病例329例临床特征及治疗情况分析　出处：《重庆医科大学》2015年硕士论文　论文类型：学位论文

  更多相关文章： 脓毒血症 临床特征 治疗

【摘要】：目的：脓毒血症为威胁生命的重症感染,对诊断为脓毒血症患者的临床特征、实验室检查结果情况及治疗进行分析,为临床上对该病的诊断及治疗提供依据。方法：收集2013年1月～2014年10月,我院全院收治病人中出院诊断为脓毒血症的患者临床资料,进行回顾性分析(诊断、发病诱因、伴随的疾病、临床特征及治疗等),统计学方法采用t检验或卡方检验。结果：本组患者一共有329例,其中男性患者155例(47.1%),女性患者1 74例(52.9%)；61-80岁150例(45.6%),81-92岁37例(11.2%),发病的诱因以慢性疾病、手术后为主(158/329,48.0%),主要表现均为发热(92.4%),发热程度以中高热为主(83.0%),平均发热时间较长,1天~3+月,伴有其他系统疾病中以泌尿道疾病尤为突出,实验室检查中血常规138例WBC10×109／L(41.9%),246例中性粒百分比75%(74.8%),白细胞低于正常值有23例(7.0%),306例降钙素原异常,平均值为23.4；最高200(13例)；C反应蛋白有197例异常(59.9%),平均值90,103例血沉异常(31.3%),平均值61；转氨酶升高93例(28.2%),1例重度升高(400 u/L,0.03%),高达1550/1750 U/L,肌酐升高113例(34.3%),最高达814umol/L,平均值为183.1 umol/L;有123例凝血功能PTA出现异常(37.4%),平均值为53.8%；血培养阳性163例,其中金黄色葡萄球菌13例(8.0%),MASA 6例,大肠埃希菌60例(36.8%),产ESBL酶23例,肺炎克雷伯菌16例(9.8%),鲍曼不动杆菌14例(8.6%),铜绿假单胞菌13例(8.0%),屎肠球菌4例(2.5%),表皮葡萄球菌4例(2,5%),人葡萄球菌5例(3.1%),溶血葡萄球菌4例(2.5%),白假丝酵母4例(2.5%),其他阳性球菌12例(7.4%),革兰阴性杆菌14例(8.6%)。多种抗生素被单独或者联合使用,最常用的抗生素为帕尼培南。结论：本组脓毒血症患者分布以感染科,ICU为主,发病特征为中老年(大于60岁),免疫功能低下合并慢性疾病患者为主(26.5%),平均体温为39.3℃,炎症指标以降钙素原异常比例最高,肝肾功能及凝血功能异常比例不到50%,但血培养阳性病例所占比例较高(49.5%),多重耐药菌株占40%,最常用的药物是碳青霉烯类,总体治疗效果较好(好转及治愈率达80.9%)。
[Abstract]:Objective: sepsis is a life-threatening severe infection, the diagnosis of clinical characteristics of patients with sepsis, situation and treatment analysis of laboratory results, and provide the basis for the diagnosis and treatment of the disease in clinic. Methods: from January 2013 to October 2014, patients admitted in our hospital hospital discharge diagnosis of clinical data of patients with sepsis the retrospective analysis (diagnosis, predisposing factors, concomitant diseases, clinical features and treatment etc.), statistical methods using t test or chi square test. Results: the group of patients with a total of 329 cases, in which 155 cases of male patients (47.1%), 174 cases of female patients (52.9%); 61-80 150 (45.6% cases), 37 cases of 81-92 years old (11.2%), the cause of the disease to chronic diseases, mainly after surgery (158/329,48.0%), mainly were fever (92.4%), the degree of fever in hyperpyrexia (83%), the average long duration of fever, 1 days ~3 +鏈，

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