全身性感染的流行病学研究

发布时间：2018-02-28 22:28

本文关键词： 全身性感染严重全身性感染感染性休克发病率病死率危险因素严重全身性感染感染性休克流行病学病死率危险因素　出处：《北京协和医学院》2015年博士论文　论文类型：学位论文

【摘要】：研究背景：目前中国大陆对全身性感染的发病情况了解仍不够全面,且尚缺乏基于人群的全身性感染流行病学研究。本研究以北京市西城区月坛街道的居民为对象,目的是了解该人群中全身性感染的发病情况,并研究全身性感染发病及死亡的危险因素。研究方法：首先,我们根据北京市公共卫生信息中心数据库筛选出2012年7月1日至2013年6月30日期间住院的所有成年患者。然后,人工查阅所有患者的住院病历。根据病历信息,挑选符合入选条件的全身性感染患者,收集并分析这些患者的相关数据。研究结果：研究期间,总住院人数为9990人,分布于111家医院。共查阅病历9108份,筛选出全身性感染患者735名,严重全身性感染患者245人,感染性休克患者108人。计算月坛街道全身性感染、严重全身性感染及感染性休克的发病率分别为571人/10万人/年,190人/10万人/年及84人/10万人/年。大部分全身性感染患者为社区获得性感染,最常见的感染部位为肺部。病原菌以革兰阴性菌最常见。全身性感染患者的住院病死率为20.1%,严重全身性感染及感染性休克患者的病死率分别为49.0%和80.6%。年龄较大、既往合并最终致死性疾病或迅速致死性疾病、合并严重全身性感染、全身性感染发病当天SOFA评分较高的患者,死亡的风险较高。而社区获得性感染患者死亡的风险较低。结论：本研究发现中国全身性感染的人群发病率高于许多其他国家,且预后较差。提示全身性感染已给中国造成了严重的疾病负担。有必要开展前瞻性研究,更确切的了解全国全身性感染的发病率、患者预后及治疗费用等。研究背景：目前关于中国大陆全身性感染的流行病学资料较少且完整性欠佳。本研究目的是了解中国大陆重症监护病房(intensive care unit, ICU)中严重全身性感染及感染性休克的发病情况及患者预后,同时对严重全身性感染及感染性休克患者预后的影响因素进行探讨。研究方法：我们在22家封闭式多学科ICU开展了一项历时两个月、前瞻性、观察性队列研究。对研究期间所有以上22家ICU的收住患者进行筛查,出现严重全身性感染及感染性休克的患者纳入本研究。研究结果：根据本研究的入选标准,共有484名患者被诊断为严重全身性感染及感染性休克并纳入研究,占所有收住ICU患者的37.3%。这些患者最常见的感染部位是肺以及腹部,ICU病死率及住院病死率分别为28.7%(139/484)和33.5%(162/484)。多因素回归分析显示,急性生理与慢性健康评分(Acute Physiology and Chronic HealthEvaluation, APACHE) Ⅱ(比值比[0R],1.068：95%可信区间[CI],1.027-1.109),合并急性呼吸窘迫综合征(OR,2.676; 95%CI,1.691-4.235),血行性感染(OR,2.520; 95%CI,1.142-5.564)以及恶性实体肿瘤病史(0R,2.246；95%CI,1.141-4.420)是死亡的独立危险因素。结论：本研究发现严重全身性感染及感染性休克在中国ICU患者中非常普遍,而且病死率高,有助于我们进一步了解中国严重全身性感染及感染性休克的流行病学情况、患者的特征及对患者进行危险分层。
[Abstract]:Background: at present, Chinese understanding of the incidence of systemic infection is still not comprehensive, and lack of systemic infection epidemiology. Based on the research on Beijing city Xicheng District Yuetan Street residents as the object, the aim is to understand the incidence of systemic infection in this population, and to study the incidence and risk factors of death systemic infection. Methods: first of all, according to the Beijing public health information center database screening all adult inpatients during the period from July 1, 2012 to June 30, 2013. Then, the artificial inspection of all the patients medical records. According to the records, select eligible patients with systemic infection, collect and analyze relevant data of these patients. Results: during the study period, the total number of hospitalizations for 9990 people, distributed in 111 hospitals. A total of 9108 copies of medical records, screening out the body The infection of 735 patients, 245 patients with severe sepsis and septic shock patients 108. Calculation of the altar on the streets of systemic infection, severe systemic infection and the incidence of septic shock rate were 571 /10 million / year, 190 /10 million / year and 84 /10 million / year most of the divided into community-acquired infection in patients with systemic infection, the most common site of the lungs. The most common pathogens in gram gram negative bacteria. Systemic infection with hospital mortality rate was 20.1%, severe systemic infection and mortality in septic shock patients were 49% and 80.6%. years of age. Had associated with diseases or rapidly fatal disease with severe systemic infection, the incidence of the SOFA scores higher in patients with systemic infection, a higher risk of death. The community acquired infection patient's risk of death was lower. Conclusion: This study found that Chinese Systemic infection incidence rate was higher than that of many other countries, and has a poor prognosis. That systemic infection has to Chinese caused serious burden of disease. It is necessary to carry out a prospective study, more precise understanding of the pathogenesis of systemic infection rate, prognosis and treatment costs. Background: at present, the body on Chinese the epidemiological data of infection is less and the integrity of the poor. The purpose of this study is to understand the Chinese, ICU (intensive care, unit, ICU) in severe sepsis and septic shock incidence and prognosis of patients, and the factors of severe systemic infections and affect the prognosis of patients with septic shock were discussed. Research methods: we in 22 closed multidisciplinary ICU conducted a lasted two months, a prospective, observational cohort study. The study period all above 22 ICU. Patient screening, severe systemic infection and septic shock were enrolled in this study. The results of this study: according to the inclusion criteria, a total of 484 patients were diagnosed as severe sepsis and septic shock were included in the study, accounting for all patients admitted to the ICU site of infection, the most common of these patients 37.3%. the lung and abdomen, ICU mortality rate and the fatality rate was 28.7% (139/484) and 33.5% (162/484). Multivariate regression analysis showed that the acute physiology and chronic health evaluation (Acute Physiology and Chronic HealthEvaluation, APACHE) 2 (odds ratio 1.068:95% CI [0R], [CI], 1.027-1.109), patients with acute respiratory distress syndrome (OR, 2.676; 95%CI, 1.691-4.235), hematogenous infection (OR, 2.520; 95%CI, 1.142-5.564) and malignant solid tumor history (0R, 2.246; 95%CI, 1.141-4.420) is an independent risk of death . conclusion: This study found that severe sepsis and septic shock in patients with ICU Chinese is very common, and the fatality rate is high, will help us understand the China serious systemic infection and septic shock in the epidemiology of patient characteristics and risk stratification of patients.

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R51

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