创伤弧菌脓毒症患者的预后影响因素分析  

Analysis of prognostic factors in patients with Vibrio vulnificus sepsis

作　　者：翁成杰 王玉萍 施若霖[1] 洪广亮[1] 赵光举[1] 卢才教[1] 杨晔琴 卢中秋[1] Weng Chengjie;Wang Yuping;Shi Ruolin;Hong Guangliang;Zhao Guangju;Lu Caijiao;Yang Yeqin;Lu Zhongqiu(Emergency Department,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;College of Nursing,Wenzhou Medical University,Wenzhou 325000,China;Integrated Service Center,Yiwu Hospital Affiliated to Wenzhou Medical University,Yiwu 322000,China)

机构地区：[1]温州医科大学附属第一医院急诊医学中心,325000 [2]温州医科大学护理学院,325000 [3]温州医科大学附属义乌医院综合服务中心,322000

出　　处：《中华急诊医学杂志》2021年第5期612-616,共5页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金(81772112,81871583);浙江省重点研发计划(2021C03072)。

摘　　要：目的探讨创伤弧菌脓毒症患者的预后影响因素。方法回顾性分析温州医科大学附属第一医院2008年1月至2019年12月67例创伤弧菌脓毒症患者的病例资料,采用单因素分析比较死亡组和治愈组在一般资料、临床表现、入院实验室指标、抗菌药物和外科手术的差异。然后将单因素分析差异有统计学意义的指标纳入多因素分析,最终得出影响患者预后的因素。结果单因素分析显示死亡组和治愈组患者是否有肝病、入院休克、多处肢体损伤、入院白细胞、血小板、pH值、白蛋白、乳酸、谷草转氨酶、肌酐、降钙素原、肌酸激酶、活化部分凝血活酶时间、凝血酶原时间差异有统计学意义(P<0.05)。多因素分析表明患者入院乳酸(OR=0.628,95%CI:0.461~0.855,P=0.003)、白蛋白(OR=1.330,95%CI:1.062~1.667,P=0.013)、肌酸激酶(OR=0.999,95%CI:0.998~1.000,P=0.016)、入院至行外科手术时间(OR=0.118,95%CI:0.015~0.938,P=0.043)是影响患者预后的重要因素。患者入院乳酸和肌酸激酶水平高、白蛋白水平低提示患者预后较差;入院至行外科手术时间≤12 h的患者预后较好。结论对于创伤弧菌脓毒症患者的救治,医护人员需在早期动态评估这些预后因素,并早期采用外科手术治疗以改善患者的预后。Objective To explore the prognostic factors of patients with Vibrio vulnificus sepsis.Methods The clinical data of 67 patients with Vibrio vulnificus sepsis from January 2008 to December 2019 in the First Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed.Univariate analysis was used to compare the differences in general information,clinical manifestations,admission laboratory indicators,antibiotics and surgery between the death group and the cured group.Then the factors with significant difference in univariate analysis were included in multivariate analysis,and the factors of prognosis were obtained.Results Univariate analysis showed that there were significant difference in liver disease,admission with hypotension shock,multiple limb injuries;admission leukocytes,platelets,pH value,albumin,lactic acid,aspartate aminotransferase,creatinine,procalcitonin,creatine kinase,activated partial thromboplastin time,prothrombin time between the death group and the cured group(all P<0.05).Multivariate analysis showed that admission lactate(OR=0.628,95%CI:0.461-0.855,P=0.003),albumin(OR=1.330,95%CI:1.062-1.667,P=0.013),creatine kinase(OR=0.999,95%CI:0.998-1.000,P=0.016)and admission surgery time(OR=0.118,95%CI:0.015-0.938,P=0.043)were risk factors of the prognosis.Patients with high lactate,creatine kinase and low albumin at admission indicate poor prognosis;patients with admission surgery time≤12 h have better prognosis.Conclusion For the treatment of patients with Vibrio vulnificus sepsis,medical staff should dynamically evaluate these prognostic factors in the early stage,and early surgical treatment should be adopted to improve the prognosis of patients.

关 键 词：创伤弧菌 脓毒症 预后 影响因素 

分 类 号：R459.7[医药卫生—急诊医学]