本文關(guān)鍵詞： 嚴重膿毒癥 膿毒癥休克 重癥監(jiān)護室 預(yù)后　出處：《重慶醫(yī)學》2016年31期 　論文類型：期刊論文

【摘要】：目的探討影響ICU危重膿毒癥患者預(yù)后的危險因素。方法回顧性分析該院重癥醫(yī)學科2005年1月至2015年1月嚴重膿毒癥、膿毒癥休克患者的臨床資料,如基本資料、基礎(chǔ)疾病及生化指標,按離開醫(yī)院時的結(jié)局將其分為康復出院組和院內(nèi)死亡組,通過非條件Logistic回歸模型對相關(guān)因素進行多因素分析。結(jié)果共收治符合膿毒癥診斷標準的患者2 587例,其中危重膿毒癥968例(37.5%),男582例,女386例,年齡(45±12)歲,康復出院458例(47.3%),組間比較后發(fā)現(xiàn)院內(nèi)死亡組年齡(58±26 vs.45±23,t=2.591,P=0.038)、APACHEⅡ評分(25±12.3 vs.16±8.5,t=2.346,P=0.032)、膿毒癥休克比例(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)、降鈣素原(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)水平均高于康復出院組,但院內(nèi)死亡組血清清蛋白(25±6.8 vs.34±8.5,t=3.212,P=0.035)水平低于康復出院組,多因素Logistic回歸分析顯示年齡、2型糖尿病、膿毒性休克、APACHEⅡ評分、降鈣素原、血清乳酸及血清清蛋白水平是影響預(yù)后的獨立危險因素(P0.05)。結(jié)論年齡、2型糖尿病、膿毒性休克、APACHEⅡ評分、降鈣素原、血清乳酸及血清清蛋白水平是影響危重膿毒癥預(yù)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.

【作者單位】： 廣東省中山市古鎮(zhèn)醫(yī)院急診科;
【基金】：廣東省中山市衛(wèi)生局醫(yī)學科研立項(2014J071)
【分類號】：R459.7
【正文快照】： 膿毒癥(sepsis)是指由感染引起的全身炎性反應(yīng),可進展為嚴重膿毒癥(severe sepsis)、膿毒癥休克(septic shock),甚至引發(fā)多器官功能障礙綜合征(MODS)。在美國嚴重膿毒癥、膿毒癥休克占ICU總住院病例的20%[1],近年診療技術(shù)雖然得到較大提高,但危重膿毒癥的總體病死率仍較高[1-2

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