本文關(guān)鍵詞：膿毒性休克患者發(fā)生頑固性休克的危險(xiǎn)因素分析　出處：《廣西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 膿毒性休克 頑固性休克 危險(xiǎn)因素 多因素分析

【摘要】：目的：探討膿毒性休克患者發(fā)生頑固性休克的危險(xiǎn)因素。 方法：同時以“膿毒癥、休克”作為診斷檢索廣西醫(yī)科大學(xué)第一附屬醫(yī)院病例庫中2011年6月至2013年12月ICU病房(EICU、內(nèi)科ICU、外科ICU)收治的病例,依據(jù)“膿毒性休克”診斷標(biāo)準(zhǔn)進(jìn)行初步篩選后再按照納入及排除標(biāo)準(zhǔn)選擇符合條件的膿毒性休克患者,根據(jù)患者入住ICU經(jīng)充分液體復(fù)蘇并應(yīng)用血管活性藥物或(和)正性肌力藥物治療6h后是否發(fā)生頑固性休克分為研究組(頑固性休克組)和對照組(可逆性休克組)。搜集并整理入選膿毒性休克患者包括一般資料、實(shí)驗(yàn)室檢查結(jié)果及相關(guān)治療情況在內(nèi)的多項(xiàng)研究指標(biāo)。先將各項(xiàng)指標(biāo)進(jìn)行單因素分析,再將有統(tǒng)計(jì)學(xué)差異的變量(P0.05為差異具有統(tǒng)計(jì)學(xué)意義)進(jìn)行多因素Logistic回歸分析,保留在Logistic回歸模型中的因素確定為發(fā)生頑固性休克有意義的獨(dú)立危險(xiǎn)因素,并根據(jù)Logistic回歸模型方程進(jìn)一步分析評價這些危險(xiǎn)因素對預(yù)測發(fā)生頑固性休克的診斷價值。 結(jié)果：單因素分析結(jié)果顯示MAP、APACHE II評分、昏迷狀態(tài)、高血壓病、MODS、肌酐、BNP、動脈血乳酸、2h乳酸清除率、Pa02、血糖、治療時限這12個研究指標(biāo)的組間比較具有統(tǒng)計(jì)學(xué)意義。將單因素分析中有統(tǒng)計(jì)學(xué)意義的研究指標(biāo)納入多因素非條件Logistic回歸模型中進(jìn)行分析,結(jié)果顯示保留在Logistic回歸模型中的獨(dú)立危險(xiǎn)因素依次是2h乳酸清除率(OR=3.166E-5)、乳酸(OR=7.751)、APACHEⅡ評分(OR=1.521)、高血壓病史(OR=1.302)、肌酐(OR=1.021)。根據(jù)Logistic回歸模型方程計(jì)算出此概率模型判斷膿毒性休克患者發(fā)生頑固性休克的準(zhǔn)確度為94.62%(123/130)、敏感度為90.91%(40/44)、特異度為96.51%(83/86),說明利用上述危險(xiǎn)因素預(yù)測膿毒性休克患者是否會進(jìn)展為頑固性休克具有較好的診斷價值。 結(jié)論：2h乳酸清除率低、高乳酸值、APACHEⅡ評分、高血壓病史、高肌酐值為膿毒性休克患者發(fā)生頑固性休克的獨(dú)立危險(xiǎn)因素,這些危險(xiǎn)因素能較好地預(yù)測膿毒性休克患者是否有發(fā)生頑固性休克的可能。
[Abstract]:Objective: to investigate the risk factors of refractory shock in septic shock patients. Methods: at the same time, "sepsis, shock" was used as a diagnostic search for EICU, ICU in ICU ward of Guangxi Medical University from June 2011 to December 2013 in the first affiliated Hospital of Guangxi Medical University. Surgical ICU admitted cases, according to the "septic shock" diagnostic criteria for preliminary screening and then according to the inclusion and exclusion criteria for the selection of qualified septic shock patients. Patients with refractory shock were divided into study group (intractable shock group) and control group (n = 6) according to whether they were treated with vasoactive drugs or / and positive muscle strength drugs or not after 6 hours of treatment according to the patients admitted to ICU with adequate fluid resuscitation. Collecting and sorting out the general data of septic shock patients in the reversible shock group. The results of laboratory examination and related treatment, including a number of research indicators. First of all, the single factor analysis of the indicators. Then the variables with statistical difference (P0.05 for the difference is statistically significant) multivariate Logistic regression analysis. The factors retained in the Logistic regression model were identified as significant independent risk factors for refractory shock. The diagnostic value of these risk factors in predicting refractory shock was further analyzed and evaluated according to the Logistic regression model. Results: the results of univariate analysis showed that MAPP Apache II score, coma state, hypertension mods, creatinine BNPs, arterial blood lactate 2 h lactate clearance rate and Pa02. Blood sugar. The comparison of the 12 study indexes with time limit of treatment was statistically significant. The study indexes with statistical significance in univariate analysis were analyzed in multivariate unconditioned Logistic regression model. The results showed that the independent risk factors retained in the Logistic regression model were 2 h lactate clearance rate (ORL) 3.166E-5 and lactate ORO 7.751respectively. The score of APACHE 鈪，

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