脓毒症发热患者预后不良的早期预警指标研究  

Early warning indicators for poor prognosis of sepsis patients with chief complaint of fever

作　　者：申晓东[1] 肖红菊[1] 张曦木[1] 陈歆[1] 翟永志[1] 刘刚[1] 黎檀实[1] 朱海燕[1] 

机构地区：[1]解放军总医院急诊科,北京100853

出　　处：《中华医院感染学杂志》2016年第20期4624-4626,共3页Chinese Journal of Nosocomiology

基　　金：国家科技重大专项(2013ZX1004805-003);解放军总医院临床科研扶持基金(2012FC-TSYS3033)

摘　　要：目的研究以发热为主诉的脓毒症患者临床资料及预后,寻找提示预后不良的早期预警指标。方法回顾性分析2014年1月-2016年1月以发热为主诉的81例脓毒症患者,根据预后分为预后良好组和预后不良组,其中预后良好组61例,预后不良组20例;比较两组间临床资料,并以预后为因变量,将组间差异指标进行logistic回归分析,以明确其与预后的关联。结果全部81例脓毒症患者中,预后不良组占24.69%,两组间年龄、性别、体质量指数等临床情况差异均无统计学意义;预后不良组中肺部感染显著高于预后良好组,预后不良组血红蛋白显著低于预后良好组,凝血酶时间显著长于预后良好组,差异均有统计学意义(P<0.05);血乳酸含量明显高于预后良好组;logistic回归分析提示血红蛋白水平与不良预后负相关,血乳酸水平和凝血酶时间与不良预后正相关。结论以发热为主诉的脓毒症患者,就诊早期的血红蛋白、血乳酸和凝血酶时间可能对预后有一定预警作用,其中较低的血红蛋白水平,较高的血乳酸水平和较长的凝血酶时间均提示患者可能出现不良的预后情况。OBJECTIVE To investigate the clinical data of sepsis patients with chlet complaint ot Iever, anatyze tne prognosis, and seek for the early warning indicators for poor prognosis. METHODS A total of 81 sepsis patients with chief compliant of fever who were treated in the hospital from Jan 2014 to Jan 2016 were retrospectively ana- lyzed and divided into the good prognosis group with 61 cases and the poor prognosis group with 20 cases according to the prognosis. The clinical data were compared between the two groups of patients, the prognosis was set as the dependent variable, and the logistic regression analysis was performed for the indexes that had between-group difference so as to define the correlation with prognosis. RESULTS Of the 81 sepsis patients, 24.69 % had the poor prognosis, and there was no significant difference in the age, gender, or body mass index between the two groups. The incidence of pulmonary infections was significantly higher in the poor prognosis group than in the good prog- nosis group~ the level of hemoglobin was significantly lower in the poor prognosis group than in the good prognosis group; the thrombin time was significantly longer in the poor prognosis group than in the good prognosis group（P 〈0.05）. The content of blood lactic acid of the poor prognosis group was significantly higher than that of the good prognosis group. The logistic regression analysis indicated that the level of hemoglobin was negatively corre- lated with the poor prognosis, and the level of blood lactic acid and thrombin tine were positively correlated with the poor prognosis. CONCLUSION The early warning indicators for theprognosis of the sepsis patients with chief compliant of fever include the hemoglobin, blood lactic acid, and thrombin time; the patients with low hemoglobin level, high blood lactic acid level, or long thrombin time may have the poor prognosis.

关 键 词：发热 脓毒症 预后 预警指标 关联 LOGISTIC回归 

分 类 号：R631.2[医药卫生—外科学]