严重腹腔感染患者临床特点及影响早期预后的危险因素  

Clinical characteristics and the risk factors related to early prognosis of severe abdominal infec-tion

作　　者：吴明[1] 赖凯[1] 任迪[1] 李明利[1] 曾晶晶[1] 吴乐锋 何云[1] 冯永文[1] 

机构地区：[1]深圳市第二人民医院重症医学科, 广东深圳518035

出　　处：《中国急救医学》2016年第7期614-619,共6页Chinese Journal of Critical Care Medicine

基　　金：深圳市科技创新委项目（JCYJ20130401112313541,JCYJ20150330102401099）

摘　　要：目的：调查严重腹腔感染患者的临床特点及影响早期（2周）预后的危险因素。方法回顾性分析我院2000－01-2015-05收治的169例严重腹腔感染患者的临床资料，按患者2周时的结局分为存活组（141例）和死亡组（28例）。其中男性127例，女性42例，平均年龄（78.6±12.8）岁；采用单因素分析和多因素Logistic回归分析筛选和判定与严重腹腔感染患者早期预后相关的独立危险因素。结果单因素分析结果显示，发病至手术时间、术中液体晶/胶体比、初始抗菌药物治疗不适当、1周内CD4和CD8细胞变化值、术后第3天液体净量、腹腔感染灶引流不充分是影响严重腹腔感染患者预后的危险因素。存活组上述指标分别为（56.8±11.3）h、1.17±0.03、11例、105±36、88±26、（-839±217）mL和7例，死亡组分别为（68.2±8.2）h、3.13±0.18、7例、-52±12、-54±19、（1438±178）mL和5例，差异均有统计学意义（P＜0.05）。Logistic回归分析表明，发病至手术的时间（OR＝3.791，95%CI：1.703-8.440，P＝0.001）、腹腔感染灶引流不充分（OR＝10.277，95%CI：1.416-73.847，P＝0.021）、术后肠内营养开始时间（OR＝46.744，95%CI：5.746-380.240， P＝0.000）是严重腹腔感染患者早期预后的独立危险因素。结论尽早手术、充分引流感染灶是患者存活的前提，术中放置肠内营养管、尽早肠内营养是患者存活的最重要方面，术后的器官功能支持是患者存活的主要手段，同时应兼顾围手术期的液体管理、动态监测CD4/CD8的变化。Objective To investigate the clinical characteristics and the risk factors for the early （two weeks）prognosis of patients with intra-abdominal infections. Methods Clinical data of 169 patients with severe abdominal infection,who were hospitalized during January 2000 and May 2015 in our hospital,were analyzed retrospectively. According to the outcome for two weeks,169 patients were divided into two groups：the survivors 141 cases;the deceased 28 cases. Of which 127 cases were male and 42 females, mean age （78.6 ± 12.8） years; The potential risk factors of severe abdominal infection patients were analyzed by univariate analysis and logistic regression analysis. Results Univariate analysis showed that the onset to surgery time, intra-operative liquid crystal colloid ratio, inappropriate initial antibiotic therapy, CD4, CD8 cells changes in one week, postoperative third days of net liquid, inadequate peritoneal drainage of intra-abdominal infection were risk factors for modality with severe abdominalinfection patients（all P〈0.05）.Survival group were（56.8±11.3）h, 1.17±0.03,11 cases, 105±36, 88± 26,（-839±217）mL and 7 cases;deceased group were（68.2±8.2）h, 3.13±0.18, 7 cases,-52±12,-54± 19,（1438±178）mL and 5 cases, all P〈0.05）;Logistic regression analysis showed that the onset to the surgery time（OR=3.791, 95% CI 1.703-8.440, P=0.001）,inadequate peritoneal drainage of intra-abdominal infection（OR=10.277, CI 1.416-73.847, P=0.021）, the start time of postoperative enteral nutrition（OR=46.744, 95%CI：5.746-380.240, P=0.000）, were the independent risk factor of early prognosis for severe abdominal infection. Conclusions Earlier operation, adequate peritoneal drainage were the premise of survival for patients, placing enteral feeding tube intra-operative, early enteral nutrition were the most important aspects of survival for patient and organ supportment for postoperative was the primary methods, perioperative fluid management, dynamic monitoring CD4/CD8 changes were

关 键 词：严重腹腔感染 临床特征 危险因素 早期预后 

分 类 号：R541.4[医药卫生—心血管疾病]