血培养阳性与阴性脓毒症休克患者间临床特征比较  

Compare the Clinical Characteristics of Culture- positive and Culture- negative Septic Shock

作　　者：冯兴林[1] 方红龙[1] 陈娟[2] 祝利华[1] 罗建[1] 张伟文[1] 

机构地区：[1]浙江省衢州市人民医院重症医学科,324000 [2]浙江省衢州市人民医院检验科,324000

出　　处：《医学研究杂志》2015年第1期139-141,共3页Journal of Medical Research

摘　　要：目的 探讨血培养阳性与阴性脓毒症休克患者间临床特征差异,为临床更好地诊治脓毒症休克提供理论依据.方法 收集2000年1月～2013年1月在笔者医院重症医学科住院的脓毒症休克患者649例,根据血培养标本的结果分为血培养阳性组（358例）和血培养阴性组（291例）,比较两组间血液学指标、APACHEⅡ评分、感染部位、并发症情况、机械通气时间、住ICU时间和住院病死率;将脓毒症休克存活患者进一步分成阳性存活组与阴性存活组,比较两组间容量管理情况.结果 血培养阳性与阴性脓毒症休克患者间APACHEⅡ评分及感染部位的比较差异无统计学意义（P＞0.05）,但阳性组机械通气时间及住ICU时间长,ARDS及心脏等脏器损害的发生率高,住院病死率高（P＜0.05）;阳性组存活患者6、12、24、48h任一时间点的液体正平衡量均较阴性组存活患者少（P＜0.05）,但7天总液体平衡量差异无统计学意义（P＞0.05）.结论 血培养阳性与阴性脓毒症休克患者临床特征差异具有统计学意义,在容量管理上,血培养阳性的脓毒症休克患者液体平衡量较阴性脓毒症休克患者少.Objective To compare the clinical characteristics of culture - positive and culture - negative septic shock, in order to provide theoretical basis for clinical diagnosis and treatment of septic shock. Methods Totally 649 cases of septic shock patients, who were from the Intensive Care Unit of quzhou people＇s hospital between January 2000 and January 2013, were divided into culture - positive group （ 358 cases） and culture - negative group （291 eases） according to results of blood culture. Compare Hematological parameters, A- PACHE Ⅱ score, infection sites, complications, duration of mechanical ventilation, duration of ICU stay and hospital mortality were com- pared retrospeceively. Survivals were divided into culture - positive and negative survival group, comparing capacity management between the two groups. Results There was no significant difference in APACHE II scores and infection sites between culture - positive and cul- ture - negative septic shock. Culturepositive patients had a longer duration of mechanical ventilation and ICU stay, higher incidence of ARDS and organ dysfunction, higher hospital mortality than culturenegative patients. Culturepositive survival group had lower net fluid balance in 6,12,24,48h than cuhurenegative survival group, but seven days total fluid balance was of no significant difference between the two group. Conclusion There were significant differences between culture - positive and negative septic shock. Cuhure - positive septic shock patients have lower fluid balance than euhure - negative septic shock patients on capacity managemen.

关 键 词：脓毒症休克 血培养 临床特征 

分 类 号：R4[医药卫生—临床医学]