影响感染性休克患者预后高危因素的临床研究  

Clinical investigation on the risk factors for prognosis in patients with septic shock

作　　者：杨斌 王锦权 陶晓根 王帝 Yang Bin;Wang Jinquan;Tao Xiaogen;Wang Di(Department of Intensive Care Unit,Anhui Provincial Hospital Affiliated to Anhui Medical University,Hefei 230036,Anhui,China)

机构地区：[1]安徽医科大学附属省立医院(南区)重症医学科,合肥230036

出　　处：《中华危重病急救医学》2019年第9期1078-1082,共5页Chinese Critical Care Medicine

基　　金：安徽省国际科技合作项目(1403062022)。

摘　　要：目的探讨影响感染性休克患者预后的高危因素,为病情评估提供可靠依据。方法回顾性分析2016年3月至2018年12月安徽医科大学附属省立医院重症医学科(ICU)收治的185例感染性休克患者的病例资料。收集患者诊断感染性休克当日血常规、血生化、血气分析、肌红蛋白(Myo)、心肌肌钙蛋白I(cTnI)、血乳酸(Lac)、降钙素原(PCT)和C-反应蛋白/白蛋白比值(CRP/Alb)等,并进行格拉斯哥昏迷评分(GCS)、快速序贯器官衰竭评分(qSOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)和多器官功能障碍评分(MODS),记录患者住院至感染性休克时间和机械通气时间。根据28 d生存情况将患者分为死亡组和存活组;根据Myo水平分为Myo升高组(Myo>98μg/L)和Myo正常组(Myo≤98μg/L),再将Myo升高患者按照28 d存活或死亡进行亚组分析。比较各组间患者的临床资料,采用多因素Logistic回归分析筛选感染性休克患者预后的影响因素。结果185例患者均纳入最终分析,其中28 d死亡106例,存活79例;血Myo升高154例,血Myo正常31例。①与感染性休克存活组相比,死亡组患者年龄较大,qSOFA、APACHEⅡ、MODS评分及血Myo、Lac、PCT水平较高,心率较快,GCS评分较低,住院至感染性休克时间和机械通气时间较短;而两组cTnI、CRP/Alb比值差异均无统计学意义。多因素Logistic回归分析显示,年龄〔优势比(OR)=1.037,95%可信区间(95%CI)为1.010~1.065,P=0.007〕、心率(OR=1.020,95%CI为1.003~1.037,P=0.023)、qSOFA评分(OR=2.839,95%CI为1.321~6.102,P=0.008)、Myo(OR=1.492,95%CI为1.088~2.045,P=0.013)、住院至感染性休克时间(OR=0.938,95%CI为0.898~0.980,P=0.004)、机械通气时间(OR=0.936,95%CI为0.899~0.975,P=0.001)是影响感染性休克患者预后的独立危险因素。②与Myo正常组相比,Myo升高组患者28 d病死率显著升高〔61.0%(94/154)比38.7%(12/31),χ2=5.259,P=0.022〕。与Myo升高的存活患者相比,死亡患者年龄较大,PCT和Objective To study the risk factors of prognosis in patients with septic shock,and to provide a reliable evidence to evaluate severity.Methods A retrospective analysis was conducted.The data of 185 patients with septic shock admitted to the intensive care unit(ICU)of Anhui Provincial Hospital Affiliated to Anhui Medical University from March 2016 to December 2018 were enrolled.Routine blood test,blood biochemistry,blood gas analysis,myoglobin(Myo),cardiac troponin I(cTnI),blood lactic acid(Lac),procalcitonin(PCT)and ratio of C-reactive protein and albumin(CRP/ALB)of patients on the day of septic shock diagnosis were collected.Glasgow coma scale(GCS),quick sequential organ failure assessment(qSOFA),acute physiology and chronic health evaluationⅡ(APACHEⅡ)and multiple organ dysfunction score(MODS)as well as the time from hospitalization to septic shock and duration of mechanical ventilation were recorded.The patients were divided into death group and survival group according to whether they survived or not on 28 days.According to Myo level,the patients were divided into two groups:Myo elevation group(Myo>98μg/L)and Myo normal group(Myo≤98μg/L).Patients with Myo elevation were divided into survival subgroup and death subgroup according to the prognosis of 28 days.The clinical data were compared among the groups,and the influencing factors of prognosis in septic shock patients were screened by multivariate Logistic regression analysis.Results 185 patients were all enrolled in the final analysis,there were 106 deaths and 79 survivors on 28 days,154 patients with elevated Myo and 31 patients with normal Myo.①Compared with the patients with septic shock in the survival group,the death group had older patients,increased qSOFA,APACHEⅡ,MODS scores and blood Myo,Lac,PCT levels,faster heart rate,decreased GCS score,and shorter time from hospitalization to septic shock and duration of mechanical ventilation.However,there was no significant difference in cTnI or CRP/Alb between the two groups.Multivariate Logistic r

关 键 词：机械通气时间 APACHEⅡ 安徽医科大学 感染性休克 省立医院 高危因素 升高组 亚组分析 

分 类 号：R54[医药卫生—心血管疾病]