天津某三甲医院四年急诊脓毒症特点回顾分析  

Characteristics of sepsis in the emergency department of a tertiary hospital in Tianjin:A 4-year retrospective analysis

作　　者：高玉雷[1] 刘艳存[1] 王力军[1] 余慕明[1] 么颖 邱钰婷 李杰 张祥 董庆云 李晨[1] 孟祥龙 陈鑫森 寿松涛[1] 柴艳芬[1] Gao Yulei;Liu Yancun;Wang Lijun;Yu Muming;Yao Ying;Qiu Yuting;LiJie;Zhang Xiang;Dong Qingyun;Li Chen;Meng Xianglong;Chen Xinsen;Shou Songtao;Chai Yanfen(Department of Emergency Medicine,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Emergency Medicine,Binhai Hospital,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Emergency Medicine,Rizhao People's Hospital,Rizhao 276800,China)

机构地区：[1]天津医科大学总医院急诊医学科,天津300052 [2]天津医科大学总医院滨海医院急诊医学科,天津300037 [3]日照市人民医院急诊医学科,曰照276800

出　　处：《中华急诊医学杂志》2022年第1期85-91,共7页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金(81871593,81701931);天津市自然科学基金(18JCQNJC10500);天津市卫生健康科技项目(ZC20177)。

摘　　要：目的以急诊医学科(emergency department, ED)为出发点, 回顾性分析脓毒症在ED患者中流行病学特点及影响死亡的危险因素, 为ED开展脓毒症"三早两降"策略提供参考。方法基于天津医科大学总医院ED和住院病案管理信息化平台, 按照2016年脓毒症国际诊断标准及2020年中国脓毒症早期预防与阻断急诊专家共识, 纳入2017年1月1日至2020年12月31日成人脓毒症ED就诊患者, 回顾性分析患者流行病学特点。采用χ^(2)检验比较死亡患者与未死亡患者的年龄、性别、住院次数、住院天数、住院费用、感染病灶部位的差异, 并采用逐步logistic回归模型分析引起经ED脓毒症住院患者死亡的影响因素。结果共纳入脓毒症ED就诊患者7 494例, 年构成比波动于3.8‰~6.1‰, 月构成比波动于2.0‰~9.0‰;以40~69岁(46.0%)、男性(59.0%)为主, 多诊断为脓毒症(96.8%), 以城职医保(59.6%)就诊为主, ED诊疗费用集中于2 000~8 000元(51.1%)。经ED脓毒症住院患者病死率为24.4%, 脓毒性休克为28.8%;以≥70岁(56.0%)、男性(56.2%)患者为主, 多为诊断脓毒症(94.0%)首次住院(76.0%), 住院中位时间为15 d, 以城职医保住院为主(65.2%), 住院费用中位数为4.7万元。患者死亡风险主要受年龄和住院时间的影响, 差异有统计学意义(P<0.01);≥70岁较18~39岁患者死亡风险高, 住院时间>7 d较≤7 d患者死亡风险低;原发感染部位主要集中于呼吸和泌尿系统, 而血液系统和腹部感染患者死亡的比例相对较高, 差异有统计学意义(P<0.01);呼吸系统和腹部感染是患者死亡的危险因素。结论脓毒症在ED就诊患者中的构成比无时间规律性, 应提高对老年男性、呼吸系统、血液系统、泌尿系统和腹部感染患者患脓毒症的警惕性。年龄较大、住院次数相对较多、住院时间相对较短、感染部位为呼吸系统或腹部的住院脓毒症患者发生死亡的风险较高。Objective Taking emergency department(ED)as a starting point,to analyze the epidemiological characteristics and mortality risk factors of sepsis,and to provide evidences for ED to carry out the strategy of“three early and two lower”for sepsis.Methods Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gcmal Hospital,adult ED patients with sepsis from January 1,2017 to December 31,2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020.The epidemiological characteristics of patients were retrospectively analyzed.Chi-square test was used to compare the difference of age,sex,hospitalization times,length of stay,hospitalization cost and infection location between dead patients and survival patients,and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results A total of 7494 patients with sepsis in ED were included in this study,and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰,respectively.The main characteristics of patients with sepsis in ED were as follows:40-69 years old(46.0%),male(59.0%),mostly diagnosed with sepsis(96.8%),mainly treated with urban health insurance(59.6%),and ED diagnosis and treatment fees of 2000-8000 Yuan(51.1%).The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%.The main characteristics of hospitalized patients with ED sepsis were as follows:most of them were male(56.2%)patients over 70 years old(56.0%),most of them were diagnosed with sepsis(94.0%)and hospitalized for the first time(76.0%),the median hospitalization time was 15 d.most of them were hospitalized under urban health insurance(65.2%),and the median hospitalization fees was 47000 Yuan.The risk factors of death were influenced by

关 键 词：急诊医学科 脓毒症 流行病学 病死率 危险因素 

分 类 号：R459.7[医药卫生—急诊医学]