重症监护治疗病房脓毒症患者预后危险因素分析

发布时间：2018-03-15 04:27

  本文选题：重症监护治疗病房　切入点：脓毒症　出处：《天津医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:探讨重症监护治疗病房脓毒症患者预后危险因素。方法:选取天津医科大学总医院2013年6月~2014年6月期间收入重症监护治疗病房进行治疗且资料完整的220例脓毒症患者为研究对象,全部患者均符合2012年SSC脓毒症诊断指南。记录患者的年龄、性别、基础疾病、感染部位等;采集入院24h内血常规、电解质、动脉血气、肝功能、肾功能等实验室指标,并根据感染部位,行相应标本进行病原微生物培养;入院时和入院后24h测定LAC值并计算24h乳酸清除率。以入院后24h内指标最差值计算急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)及SOFA评分。根据患者住院期间的预后,分为存活组与死亡组两组。将所有数据录入Excel系统,并采用SPSS21.0统计软件进行数据的处理,定量资料进行正态的检验,正态分布的定量资料以均数±标准差(x±s)表示,正态分布、方差齐的计量资料采用t检验,计数资料采用x2检验,对脓毒症患者预后的影响因素先进行单因素Logistic回归分析,在单因素分析有意义基础上进行多元Logistic回归分析。结果:(1)死亡组与存活组患者比较,在年龄、病原体感染、合并症、衰竭脏器个数、接受抗凝治疗、进行连续性血液净化,Lac、24h乳酸清除率、CRP、PCT、APACHEⅡ评分及SOFA评分有统计学意义(P0.05);在感染部位、合并心肌损伤/脓毒性脑病/急性肝损伤、基础疾病、应激性溃疡人数、TPN治疗、机械通气的时间、WBC、TBi L、PLT、氧合指数、ALT、CK-MB、Cr、BUN、AST、ALB、PT及PH无统计学意义。(P0.05)(2)单因素Logistic回归分析显示年龄、PCT、Lac、SOFA评分、APACHEⅡ评分、24h乳酸清除率、真菌感染、革兰氏阴性菌感染、合并AKI/ARDS/DIC、接受抗凝治疗、连续性血液净化与ICU脓毒症患者预后有关。(3)多元Logistic回归分析显示APACHEⅡ评分、24h乳酸清除率、ARDS、DIC是影响ICU脓毒症患者预后的独立危险因素。结论:(1)ICU脓毒症患者预后受基础疾病、感染微生物、合并症、介入治疗等多种因素影响。(2)APACHEⅡ评分、24h乳酸清除率、ARDS、DIC是影响ICU患者预后的独立危险因素。
[Abstract]:Objective: to investigate the prognostic risk factors of sepsis patients in intensive care unit. Methods: 220 patients admitted to intensive care unit from June 2013 to June 2014 were selected for treatment in Tianjin Medical University General Hospital. Cases of sepsis were studied. All the patients were in accordance with the SSC guidelines for the diagnosis of sepsis in 2012. The patients' age, sex, underlying diseases, infection site, and so on were recorded. Blood routine examination, electrolytes, arterial blood gas, liver function, renal function and other laboratory indexes were collected within 24 hours after admission. According to the site of infection, the corresponding specimens were cultured for pathogenic microorganisms. LAC was measured at admission and 24 hours after admission, and 24h lactate clearance rate was calculated. Acute physiological and chronic health status score 鈪，

本文编号：1614444