严重脓毒症与脓毒性休克患者预后分析

发布时间：2018-03-24 00:00

  本文选题：严重脓毒症　切入点：脓毒性休克　出处：《山东大学学报(医学版)》2016年10期

【摘要】：目的探讨严重脓毒症与脓毒性休克死亡危险因素,分层分析影响不同生存期患者预后的因素。方法回顾性分析2013年1月至2014年12月108例严重脓毒症与脓毒性休克患者临床资料,通过多因素Cox回归模型明确死亡的独立危险因素。结果总死亡率为53.7%,生存期30 d,30 d~89 d,90 d~365 d患者死亡率分别为27.8%、24.4%与15.3%。急性生理与慢性健康评分(APACHE-Ⅱ评分)、查尔森合并症指数(CCI)与降钙素原变化率(△PCT)是影响死亡率的独立预后因素,HR(95%CI)分别为1.105(1.066~1.146)、1.390(1.210~1.596)与0.996(0.995~0.997)。分层分析,生存期30 d者,预后因素为APACHE-Ⅱ评分(HR=1.104,95%CI:1.052~1.158)、CCI(HR=1.462,95%CI:1.204~1.775)、△PCT(HR=0.992,95%CI:0.989~0.995)与ICU住院时间(HR=0.893,95%CI:0.841~0.949);生存期30 d~89 d者,预后因素为APACHE-Ⅱ评分(HR=1.102,95%CI:1.026~1.183)与△PCT(HR=0.996,95%CI:0.994~0.998)。生存期90 d~365 d者,仅CCI(HR=1.689,95%CI:1.065~2.679)影响预后。结论 APACHE-Ⅱ评分、CCI与△PCT为影响严重脓毒症与脓毒性休克患者死亡率的独立预后因素。但对于不同生存期的死亡患者,其预后因素稍有不同,需进一步开展多中心大样本的前瞻性队列研究证实。
[Abstract]:Objective to investigate the risk factors of death in patients with severe sepsis and septic shock, and to analyze the prognostic factors of patients with different survival periods. Methods the clinical data of 108 patients with severe sepsis and septic shock from January 2013 to December 2014 were retrospectively analyzed. The independent risk factors of death were determined by multivariate Cox regression model. Results the total mortality rate was 53.7. The mortality rate of patients with 30 days of survival was 27.8% and 15.3%, respectively. The acute physiological and chronic health score was appACHE- 鈪，

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