老年脓毒症休克致急性呼吸衰竭患者预后不良危险因素分析  

Risk factors of poor prognosis in older adult patients with acute respiratory failure induced by septic shock

作　　者：吴芬[1] 杨杰[1] 赵荣美[1] 范良梅 夏余群[1] Wu Fen;Yang Jie;Zhao Rongmei;Fan Liangmei;Xia Yuqun(Department of Infectious Disease,Lishui Central Hospital,Lishui 323000,Zhejiang Province,China)

机构地区：[1]丽水市中心医院感染科,丽水323000

出　　处：《中国基层医药》2025年第2期210-213,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省医药卫生科技计划(2020ZH013)。

摘　　要：目的分析老年脓毒症休克致急性呼吸衰竭(ARF)预后的影响因素。方法回顾性分析丽水市中心医院2020年1月至2022年12月收治的146例脓毒症休克致ARF患者临床资料。根据结局是否改善分别纳入预后不良组及预后良好组, 对影响患者预后因素进行回归分析。结果 146例患者中, 预后良好者102例(69.86%), 预后不良者44例(30.14%)。预后不良组出现多重耐药菌感染率[54.54%(24/44)]、Murray肺损伤评分[(2.11±1.02)分]均高于预后良好组[23.53%(24/102)、(3.29±0.12)分](χ^(2)=13.40、t=7.63, 均P < 0.001);预后不良组β受体阻滞剂使用率[34.09%(15/44)]、氧合指数[(211.32±44.56)mmHg(1 mmHg=0.133 kPa)]血清白蛋白(Alb)[(27.02±5.21)g/L]及血清钙(Ca^(2+))[(2.19±0.25)mmol/L]水平均低于预后良好组[63.73%(65/102)、(257.46±49.65)mmHg、(30.57±5.45)g/L、(2.52±0.31)mmol/L](χ^(2)=10.89, t=5.54、3.65、6.23, 均P < 0.001);Murray肺损伤评分水平升高、出现多重耐药菌感染、Ca^(2+)及Alb水平降低等是导致脓毒症休克致ARF患者不良预后的独立危险因素(OR=1.958、2.100、2.147、2.098, 均P < 0.05), β受体阻滞剂使用是预后保护因素(OR=0.480, P=0.025)。结论多重耐药菌感染、氧合指数、Ca^(2+)及Alb水平低等均是脓毒症休克致ARF患者不良预后独立危险因素, β受体阻滞剂使用是其预后保护因素。Objective:To analyze the risk factors of poor prognosis in older adult patients with acute respiratory failure(ARF)induced by septic shock.Methods:A retrospective analysis was performed on the clinical data of 146 patients with ARF induced by septic shock who received treatment at Lishui Central Hospital between January 2020 and December 2022.According to prognosis,these patients were divided into a good prognosis group and a poor prognosis group.The factors that affect the prognosis were analyzed by regression analysis.Results:Among the 146 patients,there were 102 cases(69.86%)with a good prognosis and 44 cases(30.14%)with a poor prognosis.The incidence of multidrug-resistant bacterial infections and the Murray lung injury score in the poor prognosis group were 54.54%(24/44)and(2.11±1.02),respectively,both of which were significantly higher than those in the good prognosis group[23.53%(24/102),(3.29±0.12),χ^(2)=13.40,t=7.63,both P<0.001].In the poor prognosis group,the usage rate of beta-blockers was 34.09%(15/44),while oxygenation index and serum levels of albumin and Ca ^(2+)were(211.32±44.56)mmHg(1 mmHg=0.133 kPa),(27.02±5.21)g/L,and(2.19±0.25)mmol/L,respectively.These values were significantly lower than those in the poor prognosis group[63.73%(65/102),(257.46±49.65)mmHg,(30.57±5.45)g/L,(2.52±0.31)mmol/L,χ^(2)=10.89,t=5.54,3.65,6.23,all P<0.001].An increased Murray lung injury score,the presence of multidrug-resistant bacterial infections,and decreased serum levels of Ca ^(2+)and albumin were independent risk factors for poor prognosis in patients with ARF induced by septic shock(OR=1.958,2.100,2.147,2.098,all P<0.05).Conversely,the use of beta-blockers was identified as a protective factor for prognosis(OR=0.480,P=0.025).Conclusions:Multidrug-resistant bacterial infections,low oxygenation index,and decreased serum levels of Ca ^(2+)and albumin are independent risk factors for poor prognosis in patients with ARF induced by septic shock.Conversely,the use of beta-blockers serves as a protective fact

关 键 词：休克 脓毒性 呼吸功能不全 血清白蛋白 钙 预后 影响因素分析 老年人 

分 类 号：R459.7[医药卫生—急诊医学] R563.8[医药卫生—治疗学]