重症监护病房感染相关性淤积性黄疸患者的临床分析  

The clinical analysis of severe sepsis induced cholestasis jaundice patients in intensive care unit

作　　者：徐前程 查磊[1] 刘小彬[1] 陈尚华[1] 

机构地区：[1]皖南医学院附属芜湖市第二人民医院,241000

出　　处：《实用医技杂志》2016年第1期11-15,共5页Journal of Practical Medical Techniques

摘　　要：目的 探讨重症监护病房（ICU）收治的重症感染相关性淤积性黄疸（SSICJ）患者的流行病学特点及其死亡危险因素,提高对ICU中SSICJ的认识并指导临床救治与预后评估。方法 采用回顾性研究方法,选取2011年1月至2013年12月皖南医学院附属芜湖市第二人民医院重症医学科收治的重症感染并发淤积性黄疸患者60例,根据死亡结果分为存活组与死亡组,收集临床资料,进行临床特征分析与统计描述,采用Logistic回归分析明确SSICJ患者死亡的独立危险因素。结果 最常见感染部位为肺部感染42%（25/60）,腹腔感染22%（13/60）,血流感染12%（7/60）,52例患者共分离出病原菌73株,其中革兰阳性菌22株（30%）,革兰阴性菌35株（48%）,真菌16株（22%）,院内感染29例（48%）。ICU SSICJ患者病死率为35%（21/60）,并发院内感染患者病死率达41%（12/29）,合并慢性疾病者病死率为54%（13/27）,真菌感染病死率为64%（9/14）,伴有脓毒性休克患者的病死率高达77%（17/22）。死亡组患者胆红素持续上升例数较存活组明显增加：[0（0/31）和86%（18/21）,P〈0.01],转氨酶上升不明显[（82±21）U/L和（89±27）U/L,P=0.30]。Logistic回归分析显示：APACHEⅡ评分[优势比（OR）=2.34,95%CI 1.20~5.81,P=0.032]、合并脓毒性休克[OR=4.43,95%CI 1.76~7.38,P=0.049]、入ICU前治疗时间长短[OR=1.56,95%CI1.05~3.78,P=0.015]为ICU重症感染相关性淤积性患者死亡的独立危险因素。结论 SSICJ是ICU常见疾病,合并死亡危险因素的患者应给予更为密切的监测和积极的治疗。Objective To investigate the epidemiological characteristics and prognosis assessment mortality risk factors of severe sepsis induced cholestasis jaundice （SSICJ） patients admitted into intensive care unit （ICU）, and to strengthen acknowledge of SSICJ and guild clinical treatment. Methods The clinical data of 60 SSICJ patients were retrospectively analyzed with statistical description. All the patients admitted to the ICU of the Wuhu second people＇s hospital affiliated to Wannan medical college from January 2011 to December 2013 were assigned to tWo groups （survival group and non-survival group） according to the survival outcome. Logistic regression analysis was employed to identify independent risk factors of the death of SSICJ during ICU stay. Results The respiratory system was the most common site of infection [42% （25/60） ], followed by abdominal infection and blood stream infection 22% （13/60）, 12% （7/60） respectively. Fifty-two patients were positive in bacterial isolation and 73 strains were identified, Gram-negative bacteria was the most common pathogens [48%（35/73）], followed by Gram-positive bacteria [30%（22/73）] and fungi [22% （16/73）]. Nosocomial infections accounted for [48%（29/60）] of the enrolled patients. Overall ICU mortality of SSICJ patients was [35%（21/60）], with nosocomial infections and chronic disease infections, septic shock, the ICU mortality were increased to [41% （12/29） ], [64% （9/14） ], [77% （17/22） l respectively. The patient with continue increaseing cholestasis jaundice in non-survival group was more than survival group [0% （0/31） vs 86%（ 18/21 ）, P〈0.01 ], the AST was similar in the two groups [ （82±21） U/L vs （89±27） U/L, P=0.30 ]. Logistic regression analysis showed that APACHE Ⅱ scores [odds （OR）=2.34, 95%CI 1.20-5.81, P=0.032], coexist with septic shock （OR=4.43, 95%CI 1.76-7.38, P= 0.049）, pre-ICU therapy time （OR=1.56,95%CI 1.05-3.78, P=0.015） were the independent risk factors of ICU

关 键 词：黄疸 阻塞性 流行病学因素 重症监护病房 

分 类 号：R575[医药卫生—消化系统]