影响监护室危重脓毒症患者预后的多因素分析

发布时间：2018-01-21 00:32

本文关键词： 严重脓毒症脓毒症休克重症监护室预后　出处：《重庆医学》2016年31期 　论文类型：期刊论文

【摘要】：目的探讨影响ICU危重脓毒症患者预后的危险因素。方法回顾性分析该院重症医学科2005年1月至2015年1月严重脓毒症、脓毒症休克患者的临床资料,如基本资料、基础疾病及生化指标,按离开医院时的结局将其分为康复出院组和院内死亡组,通过非条件Logistic回归模型对相关因素进行多因素分析。结果共收治符合脓毒症诊断标准的患者2 587例,其中危重脓毒症968例(37.5%),男582例,女386例,年龄(45±12)岁,康复出院458例(47.3%),组间比较后发现院内死亡组年龄(58±26 vs.45±23,t=2.591,P=0.038)、APACHEⅡ评分(25±12.3 vs.16±8.5,t=2.346,P=0.032)、脓毒症休克比例(69.8%vs.40.6%,χ2=4.122,P=0.041)、2型糖尿病比例(1.1%vs.5.5%,χ2=8.106,P=0.036)、降钙素原(8.1±2.8 vs.2.5±5.3,t=3.681,P=0.041)及血清乳酸(5.2±2.5 vs.9.2±3.5,t=3.512,P=0.039)水平均高于康复出院组,但院内死亡组血清清蛋白(25±6.8 vs.34±8.5,t=3.212,P=0.035)水平低于康复出院组,多因素Logistic回归分析显示年龄、2型糖尿病、脓毒性休克、APACHEⅡ评分、降钙素原、血清乳酸及血清清蛋白水平是影响预后的独立危险因素(P0.05)。结论年龄、2型糖尿病、脓毒性休克、APACHEⅡ评分、降钙素原、血清乳酸及血清清蛋白水平是影响危重脓毒症预后的高危因素。
[Abstract]:Objective to investigate the prognostic factors of ICU severe sepsis. Methods a retrospective analysis of the hospital ICU from January 2005 to January 2015 in severe sepsis, the clinical data of patients with septic shock, such as basic data, basic diseases and biochemical indexes, to leave the hospital the outcome will be divided into the rehabilitation group and hospital death group, the non conditional Logistic regression model for multivariate analysis of factors related to patients. Results 2587 cases were treated with sepsis diagnostic criteria, 968 patients with severe sepsis (37.5%), of which 582 cases of male, female 386 cases, age (45 + 12) years old, 458 cases were discharged from the hospital (47.3%), comparison between groups after hospital death age group (58 + 26 + 23 vs.45, t=2.591, P=0.038), APACHE score (25 + 12.3 + 8.5 vs.16, t=2.346, P=0.032), septic shock ratio (69.8%vs.40.6%, X 2= 4.122, P=0.041), the proportion of type 2 diabetes mellitus (1.1%vs.5.5%, X 2=8.106, P=0.036), procalcitonin (8.1 + 2.8 + 5.3 vs.2.5, t=3.681, P=0.041) and serum lactate (5.2 + 2.5 + 3.5 vs.9.2, t=3.512, P=0.039) were higher than that of rehabilitation group, but died in the hospital blood albumin group (25 + 6.8 + 8.5 vs.34, t=3.212, P=0.035) the level is lower than the rehabilitation group, multivariate Logistic regression analysis showed that age, type 2 diabetes, septic shock, APACHE score, procalcitonin, serum lactic acid and serum albumin level were independent prognostic factors (P0.05). Conclusion age, type 2 diabetes, septic shock, APACHE score, drop calcitonin, serum lactic acid and serum albumin level were risk factors influencing the prognosis of severe sepsis.

【作者单位】：广东省中山市古镇医院急诊科;
【基金】：广东省中山市卫生局医学科研立项(2014J071)
【分类号】：R459.7
【正文快照】： 脓毒症(sepsis)是指由感染引起的全身炎性反应,可进展为严重脓毒症(severe sepsis)、脓毒症休克(septic shock),甚至引发多器官功能障碍综合征(MODS)。在美国严重脓毒症、脓毒症休克占ICU总住院病例的20%[1],近年诊疗技术虽然得到较大提高,但危重脓毒症的总体病死率仍较高[1-2

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