本文選題：重癥監(jiān)護治療病房　切入點：膿毒癥　出處：《天津醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的:探討重癥監(jiān)護治療病房膿毒癥患者預后危險因素。方法:選取天津醫(yī)科大學總醫(yī)院2013年6月~2014年6月期間收入重癥監(jiān)護治療病房進行治療且資料完整的220例膿毒癥患者為研究對象,全部患者均符合2012年SSC膿毒癥診斷指南。記錄患者的年齡、性別、基礎疾病、感染部位等;采集入院24h內血常規(guī)、電解質、動脈血氣、肝功能、腎功能等實驗室指標,并根據(jù)感染部位,行相應標本進行病原微生物培養(yǎng);入院時和入院后24h測定LAC值并計算24h乳酸清除率。以入院后24h內指標最差值計算急性生理和慢性健康狀況評分Ⅱ(APACHEⅡ)及SOFA評分。根據(jù)患者住院期間的預后,分為存活組與死亡組兩組。將所有數(shù)據(jù)錄入Excel系統(tǒng),并采用SPSS21.0統(tǒng)計軟件進行數(shù)據(jù)的處理,定量資料進行正態(tài)的檢驗,正態(tài)分布的定量資料以均數(shù)±標準差(x±s)表示,正態(tài)分布、方差齊的計量資料采用t檢驗,計數(shù)資料采用x2檢驗,對膿毒癥患者預后的影響因素先進行單因素Logistic回歸分析,在單因素分析有意義基礎上進行多元Logistic回歸分析。結果:(1)死亡組與存活組患者比較,在年齡、病原體感染、合并癥、衰竭臟器個數(shù)、接受抗凝治療、進行連續(xù)性血液凈化,Lac、24h乳酸清除率、CRP、PCT、APACHEⅡ評分及SOFA評分有統(tǒng)計學意義(P0.05);在感染部位、合并心肌損傷/膿毒性腦病/急性肝損傷、基礎疾病、應激性潰瘍人數(shù)、TPN治療、機械通氣的時間、WBC、TBi L、PLT、氧合指數(shù)、ALT、CK-MB、Cr、BUN、AST、ALB、PT及PH無統(tǒng)計學意義。(P0.05)(2)單因素Logistic回歸分析顯示年齡、PCT、Lac、SOFA評分、APACHEⅡ評分、24h乳酸清除率、真菌感染、革蘭氏陰性菌感染、合并AKI/ARDS/DIC、接受抗凝治療、連續(xù)性血液凈化與ICU膿毒癥患者預后有關。(3)多元Logistic回歸分析顯示APACHEⅡ評分、24h乳酸清除率、ARDS、DIC是影響ICU膿毒癥患者預后的獨立危險因素。結論:(1)ICU膿毒癥患者預后受基礎疾病、感染微生物、合并癥、介入治療等多種因素影響。(2)APACHEⅡ評分、24h乳酸清除率、ARDS、DIC是影響ICU患者預后的獨立危險因素。
[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，

本文編號：1614444