胃肠道功能衰竭对脓毒症患者临床预后的影响  

Effects of gastrointestinal failure on clinical prognosis in patients with sepsis

作　　者：秦龙[1] 张颖萍[1] 刘秋旻 路建荣[1] 颜卫峰[1] 李晶铃[1] 

机构地区：[1]北京市海淀医院ICU,北京100080

出　　处：《中国急救医学》2014年第1期27-30,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨胃肠道功能衰竭（GIF）在脓毒症患者中的发病特点以及对临床预后的影响。方法回顾性分析2011—10～2012—10北京市海淀医院ICU收治的110例脓毒症患者。人选患者在ICU期间的病例资料中至少具有下列三项因素之一者即诊断GIF：即肠内喂养不耐受（FI）、胃肠道出血（GIH）和麻痹性肠梗阻（PI）。记录其人口统计学和入选研究时的临床基本资料等25项指标，以及并发GIF的基本情况；对上述资料先进行单因素分析，然后选择有统计学差异的因素进行多因素非条件Logistic回归分析。主要研究终点为ICU死亡。结果共有72例（65．5％）脓毒症患者发生GIF，其中FI＋PI的GIF类型所占比例最高，为44％；与非GIF组相比，GIF组的ICU病死率更高（47．2％比21．1％，P=0．007）以及ICU住院时间更长[（18．6±13．6）d比（14．2±7．8）d，P=0．035]；Logistic回归分析结果显示，早期血小板计数（PLT）降低和血乳酸水平升高以及发生GIF是脓毒症患者的独立死亡危险因素，其相对危险度（OR）分别为1．994、1．729倍和2．124倍。结论GIF是脓毒症患者的常见并发症并能明显影响临床预后；早期PLT降低和血乳酸水平升高以及发生GIF的脓毒症患者的死亡风险较高，并能预测脓毒症患者的预后。Objective To study clinical characteristics and prognosis associated with gastrointestinal failure （GIF） in patients with sepsis. Methods A retrospective analysis of adult GIF patients with sepsis （n = 110） admitted to ICU in Beijing Haidian Hospital between October 2011 and October 2012 was performed. GIF was defined as documented gastrointestinal problems （food intolerance, gastrointestinal haemorrhage, and/or paralytic ileus） in the patient data at any period of their ICU stay. Twenty - five factors of the demographic characteristics, clinical information and data of the GIF were recorded upon patient record. The primary end point was ICU mortality. Simple logistic regression was analyzed for all the risk factors and variables statistically significant were chosen for multivariate and unconditioned Logistic regression analysis. Results GIF was identified in 72 patients （65.5% of all patients）, the proportion of GIF with FI and PI is the highest parts （44% of all patients）. GIF was related to significantly higher mortality （47.2% vs 21.1% in patients without GIF, P =0.007）, as well as prolonged length of ICU stay [ （18.6± 13.6） d vs （14.2 ± 7.8） d, P = 0. 035 ], respectively. The early decreased levels of PLT （ OR = 1. 994, 95% CI 1. 989 - 1. 998, P = 0. 009 ） and the increased levels of serum lactate （ OR = 1. 729,95 % CI 1. 275 - 2. 345, P = 0.000） and the development of GIF （ OR = 2. 124, 95% CI 2. 041 - 2. 378, P = 0. 000） were independent risk factors of death for patients in sepsis. Conclusion GIF represents a relevant clinical problem accompanied by an increased mortality, longer ICU stay. Risk of death with the decreased levels of PLT and the increased levels of serum lactate and the development of GIF is higher in patients with sepsis.

关 键 词：脓毒症 胃肠道功能衰竭(GIF) Logistic回归分析 肠内营养不耐受(FI) 胃肠道出血(GIH) 麻痹性肠梗阻(PI) 

分 类 号：R657.510.6[医药卫生—外科学]