某三甲医院2012年及2022年两年度脓毒性休克患者病死率比较及预后影响因子分析  

Comparison of mortality and prognostic factors analysis in patients with septic shock in 2012 and 2022 in a Grade-A hospital

作　　者：屈怡帆 魏兵[1] 王军宇[1] 武军元[1] Qu Yifan;Wei Bing;Wang Junyu;Wu Junyuan(Emergency Medical Center,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院急诊医学中心,北京100043

出　　处：《中国医师杂志》2025年第2期178-183,共6页Journal of Chinese Physician

基　　金：北京市医院管理中心青年人才培养“青苗”计划项目(QML20230313)。

摘　　要：目的比较北京朝阳医院急诊科监护室2012、2022年度脓毒性休克患者的病死率,分析各年度影响患者预后的危险因素。方法按照脓毒性休克诊断标准,纳入北京朝阳医院急诊科监护室2012年收治的脓毒性休克患者82例,2022年收治的脓毒性休克患者52例。比较各年度患者的临床资料和可能影响预后的相关指标,采用多因素logistic回归分析法筛选各年度脓毒性休克患者死亡的危险因素,并绘制受试者工作特征(ROC)曲线评价危险因素对患者死亡的预测价值。结果2012年度收治的脓毒性休克患者,死亡30例,存活52例,病死率为36.59%;2022年度收治的脓毒性休克患者,死亡16例,存活36例,病死率为30.77%;2012、2022年度脓毒性休克患者的病死率比较差异有统计学意义(χ^(2)=6.805,P=0.009)。在2012、2022年度,不同性别、年龄、序贯器官衰竭评估(SOFA)评分的脓毒性休克患者,其病死率差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,性别(OR=1.554,P=0.037)、乳酸(OR=1.062,P=0.035)及SOFA评分(OR=1.199,P=0.028)是影响2012年患者预后的危险因素,性别(OR=1.234,P=0.023)、总胆固醇(OR=1.358,P=0.028)及SOFA评分(OR=1.388,P=0.034)是影响2022年患者预后的危险因素。ROC曲线分析结果显示,SOFA评分预测2012年脓毒性休克患者死亡的灵敏度及特异度均较高(均P<0.05),乳酸、总胆固醇、SOFA评分预测2022年脓毒性休克患者死亡的灵敏度及特异度均较高(均P<0.05)。结论2022年度脓毒性休克患者病死率较2012年下降,男性患者的发病率及病死率仍高于女性患者,且患者病死率随年龄增加而增加。SOFA评分为影响2012、2022年脓毒性休克患者预后的独立危险因素。ObjectiveTo compare the mortality of patients with septic shock in the intensive care unit of the emergency department of Beijing Chaoyang Hospital in 2012 and 2022,and analyze the risk factors affecting the prognosis of patients in each year.MethodsAccording to the diagnostic criteria of septic shock,82 patients with septic shock admitted to the ICU of the emergency department of Beijing Chaoyang Hospital in 2012 and 52 patients with septic shock admitted to the ICU in 2022 were included.The clinical data of patients in each year and the related indicators that may affect the prognosis were compared.The risk factors of death in patients with septic shock in each year were screened by multivariate logistic regression analysis,and the predictive value of risk factors on death was evaluated by receiver operating characteristic(ROC)curve.ResultsIn 2012,30 patients with septic shock died and 52 survived.The fatality rate was 36.59%.In 2022,16 patients with septic shock died and 36 survived,with a fatality rate of 30.77%.There was significant difference in mortality between 2012 and 2022(χ^(2)=6.805,P=0.009).In 2012 and 2022,the mortality of septic shock patients with different gender,age and Sequential Organ failure assessment(SOFA)score had statistical significance(P<0.05).Multivariate logistic regression analysis showed that gender(OR=1.554,P=0.037),lactic acid(OR=1.062,P=0.035)and SOFA score(OR=1.199,P=0.028)were the risk factors affecting the prognosis of patients in 2012,gender(OR=1.234,P=0.028),total cholesterol(OR=1.358,P=0.028)and SOFA score(OR=1.388,P=0.034)were the risk factors affecting the prognosis of patients in 2022.ROC curve analysis results showed that SOFA score had higher sensitivity and specificity in predicting death of septic shock patients in 2012(all P<0.05),and lactic acid,total cholesterol and SOFA score had higher sensitivity and specificity in predicting death of septic shock patients in 2022(all P<0.05).ConclusionsThe case fatality rate of septic shock patients in 2022 is lower than that

关 键 词：休克 脓毒性 病死率 预后危险因素 SOFA评分 

分 类 号：R47[医药卫生—护理学]