严重多发伤患者手术治疗后继发脓毒症的影响因素分析  

Influencing factors of secondary sepsis in patients with severe multiple injuries after surgical treatment

作　　者：宋涛 訾盼盼[2] 王遣 Song Tao;Zi Panpan;Wang Qian(Department of Emergency,Zhongzhan District People′s Hospital of Jiaozuo City,Jiaozuo 454191,China;Department of Comprehensive Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]焦作市中站区人民医院急诊科,焦作454191 [2]郑州大学第一附属医院综合ICU,郑州450000

出　　处：《中国临床实用医学》2023年第5期45-49,共5页China Clinical Practical Medicine

摘　　要：目的:探讨严重多发伤患者手术治疗后继发脓毒症的影响因素。方法:本研究为横断面研究,选取2019年10月至2022年10月焦作市中站区人民医院急诊科收治的426例行手术治疗的严重多发伤患者,男260例,女166例,年龄(53.64±8.72)岁,年龄范围为28~79岁。收集患者一般资料及术后脓毒症的发生情况,采用单因素分析和二元logistic回归分析严重多发伤患者手术治疗后继发脓毒症的独立影响因素。结果:继发脓毒症患者70例,未发生脓毒症患者356例,脓毒症发生率为16.4%(70/426);单因素分析显示,继发脓毒症患者与未发生脓毒症患者年龄、创伤严重程度(ISS)评分、序贯器官衰竭(SOFA)评分、受伤至接受治疗时间、抗生素治疗情况、出血量、血清降钙素原水平、C-反应蛋白(CRP)水平、白细胞介素-17(IL-17)水平、ICU住院时间比较,差异有统计学意义( P<0.05);多因素分析显示,年龄增加、ISS评分升高、SOFA评分升高、受伤至接受治疗时间延长、出血量增加、降钙素原水平升高、CRP水平升高、IL-17水平升高是严重多发伤患者手术治疗后继发脓毒症的独立危险因素,使用抗生素治疗是严重多发伤患者手术治疗后继发脓毒症的独立保护因素( P<0.05)。 结论:年龄、ISS评分、SOFA评分、受伤至手术时间、出血量、抗生素治疗情况、降钙素原水平、CRP水平、IL-17水平是严重多发伤患者手术治疗后继发脓毒症的独立影响因素。ObjectiveTo investigate the influential factors of secondary sepsis in patients with severe multiple injuries after surgical treatment.MethodsThis study was a cross-sectional study,a total of 426 patients with severe multiple injuries undergoing surgical treatment were selected from the department of Emergency in Zhongzhan District People′s Hospital of Jiaozuo City from October 2019 to October 2022,including 260 males and 166 females,aged(53.64±8.72)years old,ranging form 28 to 79 years old.General data of patients and the occurrence of postoperative sepsis were collected.Univariate analysis and binary logistic regression were used to analyze the independent influencing factors of secondary sepsis in patients with severe multiple injuries after surgery treatment.ResultsA total of 70 patients had secondary sepsis and 356 patients had no sepsis.The incidence of sepsis was 16.4%(70/426).Single factor analysis showed that age,trauma severity(ISS)score,sequential organ failure(SOFA)score,time from injury to treatment,antibiotic treatment,blood loss,serum levels of procalcitonin(PCT),C-reactive protein(CRP),interleukin-17(IL-17),and length of ICU stay in patients with secondary sepsis and those without sepsis,the differences were statistically significant(P<0.05).Multivariate analysis showed that age,ISS score,SOFA score,time from injury to treatment,blood loss,serum levels of PCT,CRP level and IL-17 were independent risk factors of secondary sepsis in patients with severe multiple injuries after surgery.Antibiotic therapy is an independent protective factor for secondary sepsis in patients with severe multiple injuries after surgery(P<0.05).ConclusionsAge,ISS score,SOFA score,time from injury to operation,amount of blood loss,antibiotic treatment,serum levels of PCT,CRP level and IL-17 were independent influencing factors of secondary sepsis in patients with severe multiple injury after surgery.

关 键 词：多发伤 脓毒症 影响因素 C-反应蛋白 白细胞介素-17 

分 类 号：R641[医药卫生—外科学] R459.7[医药卫生—临床医学]