急诊脓毒症患者预后的相关因素分析  

Analysis of prognostic factors in ED patients with sepsis

作　　者：吕俊华[1] 时雨 王丹[1] 裴红红[1] 王海[1] Lv Jun-hua;Shi Yu;Wang Dan;Pei Hong-hong;Wang Hai(The Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710004,China)

机构地区：[1]西安交通大学第二附属医院急诊科,陕西西安710004

出　　处：《中国急救医学》2019年第3期260-263,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的分析急诊科脓毒症患者的流行病学特点、入院时的实验室检查资料特征,探讨影响急诊脓毒症患者28d生存率的相关因素。方法收集2017年1月至2018年4月期间西安交通大学第二附属医院经急诊科收治的脓毒症患者302例,根据28d预后分为生存组238例和死亡组64例。统计性别、年龄、报销方式、基础疾病、住院时间、预后、入院时的实验室检查资料、快速器官衰竭(qSOFA)评分、序贯器官衰竭评估(SOFA)评分、急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分等数据,并作预后分析。结果单因素分析发现年龄,入院当天最高脉搏、呼吸频率,最低平均动脉压、SOFA评分、qSOFA评分、APACHEⅡ评分,生化、凝血相关指标及入院后的治疗与预后相关,生存组与死亡组比较差异有统计学意义。生存组年龄(58.36±20.19)岁,低于死亡组(68.03±17.49)岁(P=0.317)。生存组住院时间(14.97±10.98)d,高于死亡组(6.03±7.23)d(P<0.001)。多因素Logistic回归分析显示,住院时间和入院当天SOFA评分与脓毒症28d生存率相关,OR值分别为0.89(0.82,0.96)和1.40(1.22,1.59)。ROC曲线分析显示,SOFA评分对脓毒症28d生存率具有较高预测价值,ROC曲线下面积为0.84(0.78,0.90),临界值为8分,敏感度为72%,特异度为83%。结论SOFA评分可用于脓毒症患者的预后评估,在诊疗过程中动态评估,有利于掌握患者病情,给予患者最合适的诊疗。Objective To explore the related factors influencing the 28-day survival rate of sepsis in the emergency department based on an open database.Methods A retrospective case-control study was done to analyze the related factors of patients who underwent sepsis in ED from January 2017 to April 2018.Results A total of 302 cases were included in the study and were divided into survival group(n=238)and death group(n=64)according to the prognosis of 28 days.Univariate analysis revealed that age,peak pulse,respiratory frequency,mean arterial pressure,SOFA,qSOFA,APACHE Ⅱ scores,biochemical and coagulation-related parameters,and treatment related to prognosis,the difference was statistically significant between the surviving and death groups.The survival group had a lower age(5 36 ± 20.19)than the death group(68.03 ± 17.49)years,P=0.317.The length of stay in the survival group was(14.97 ± 10.98)was higher than that in the death group(6.03 ± 7.23)(P<0.001).Multivariate logistic regression analysis showed that SOFA scores,length of study were related to the 28-day survival.The OR values were 0.89(0.82,0.96)and 1.40(1.22,1.59),respectively.ROC curve analysis showed that the SOFA score had a high predictive value for the 28-day survival rate of sepsis.The ROC area was 0.84(0.78,0.90),the critical value was 8 points,the sensitivity was 72%,and the specificity was 83%.Conclusion Patients with sepsis have a serious condition and poor prognosis.SOFA score is a reliable indicator to predict prognosis.In the course of diagnosis and treatment,patients should be continuously evaluated for changes in condition and the patient should be given the most suitable diagnosis and treatment.

关 键 词：脓毒症 影响因素 快速器官衰竭(qSOFA)评分 序贯器官衰竭评估(SOFA)评分 急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]