严重脓毒症/脓毒性休克患者预后的影响因素研究  

Influencing Factors of Prognosis in Patients with Severe Sepsis/Septic Shock

作　　者：黄鲜[1] 王雪[2] 王平[1] 杨娇[1] 张丽涓[1] 闫芳[1] 

机构地区：[1]四川省成都市第五人民医院重症医学科,611130 [2]西安交通大学医学院第一附属医院重症医学科,陕西省西安市710061

出　　处：《实用心脑肺血管病杂志》2017年第12期26-29,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：四川省卫生厅基金项目(120527)

摘　　要：目的分析严重脓毒症/脓毒性休克患者预后的影响因素。方法选取2013年1月—2015年5月成都市第五人民医院收治的严重脓毒症/脓毒性休克患者96例,根据患者预后分为存活组71例和死亡组25例。比较两组患者临床特征、病原学检查结果及治疗前后心功能指标,严重脓毒症/脓毒性休克患者预后的影响因素分析采用多因素Logistic回归分析。结果两组患者性别、年龄、慢性阻塞性肺疾病发生率、慢性肾脏病发生率、心脏病发生率、阿尔茨海默症发生率、创伤/手术史、糖皮质激素使用率、多巴胺使用率、去甲肾上腺素使用率、肺部/胸腔感染发生率、腹腔感染发生率、血液感染发生率、泌尿系统感染发生率、皮肤软组织感染发生率、其他部位感染发生率、早期目标导向性治疗(EGDT)6 h复苏液量、重症监护室(ICU)入住时间及革兰阳性菌、革兰阴性菌、真菌所占比例比较,差异无统计学意义(P>0.05);两组患者治疗1 d、3 d急性生理学与慢性健康状况评价系统Ⅱ(APACHEⅡ)评分比较,差异有统计学意义(P<0.05)。两组患者治疗前和治疗1 d、3 d平均动脉压(MAP)、中心静脉压(CVP)、每搏输出量(SV)、总外周阻力指数(TPRI)、心脏指数(CI)、肺动脉楔压(PCAP)比较,差异无统计学意义(P>0.05);两组患者治疗前和治疗1 d、3 d左心室射血分数(LVEF)、左心室做功指数(LCWI)比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,APACHEⅡ评分[OR=0.90,95%CI(0.87,0.96)]、LVEF[OR=0.67,95%CI(0.60,0.76)]、LCWI[OR=0.89,95%CI(0.85,0.94)]是严重脓毒症/脓毒性休克患者预后的影响因素(P<0.05)。结论 APACHEⅡ评分、LVEF、LCWI是严重脓毒症/脓毒性休克患者预后的影响因素。Objective To analyze the influencing factors of prognosis in patients with severe sepsis/septic shock.Methods A total of 96 patients with severe sepsis/septic shock were selected in the Fifth People＇ s Hospital of Chengdu from January 2013 to May 2015,and they were divided into survival group（ n = 71） and death group（ n = 25） according to the prognosis. Clinical features,etiological examination results and index of cardiac function before and after treatment were compared between the two groups, multivariate Logistic regression analysis was used to analyze the influencing factors of prognosis in patients with severe sepsis/septic shock. Results No statistically significant differences of gender,age,incidence of chronic obstructive pulmonary disease,chronic kidney disease,heart disease or Alzheimer＇ s disease,trauma/surgical history,usage rate of glucocorticoids, dopamine or noradrenaline, incidence of pulmonary/thoracic cavity infection, abdominal infection,blood infection,urinary system infection,skin soft-tissue infection or other parts infection,resuscitation fluids volume within 6 hours after early goal-directed therapy（ EGDT）,ICU stays,proportion of Gram-positive bacteria,Gram-negative bacteria or fungus was found between the two groups（ P〉0.05）,while there was statistically significant differences of APACHEⅡ score1 day and 3 days after treatment between the two groups（ P〈0.05）. No statistically significant differences of MAP,CVP,SV,TPRI,CI or PCAP was found between the two groups before treatment,1 day or 3 days after treatment（ P〉0.05）,while there were statistically significant differences of LVEF and LCWI between the two groups before treatment,1 day and 3 days after treatment（ P〈0.05）. Multivariate Logistic regression analysis results showed that,APACHE Ⅱ score [OR = 0. 90,95% CI（ 0. 87,0. 96） ],LVEF [OR = 0. 67,95% CI（ 0. 60,0. 76） ] and LCWI [OR = 0. 89,95% CI（ 0. 85,0. 94） ] were influencing factors of prognosis in patients with severe sepsis/sep

关 键 词：脓毒症 预后 影响因素分析 

分 类 号：R631[医药卫生—外科学]