ICU脓毒症相关性肝损伤临床特点分析  

Analysis of the incidence and clinical characteristics of sepsis-associated liver injury in Anhui province

作　　者：陈永雨 汤家才 徐丙金 邵敏[2] 刘念[2] 彭晓春[2] CHEN Yong-yu;TANG Jia-cai;XU Bing-jin(Department of Critical Care Medicine,Lai'an County People's Hospital 239200)

机构地区：[1]来安县人民医院重症医学科,239200 [2]安徽医科大学第一附属医院重症医学科,230022

出　　处：《肝胆外科杂志》2025年第1期60-65,共6页Journal of Hepatobiliary Surgery

摘　　要：目的本研究旨在分析安徽省多家重症监护病房(Intensive care unit,ICU)脓毒症相关性肝损伤(Sepsis-associ-ated liver injury,SALI)的特点和预后因素。方法在这项前瞻性,多中心、观察性研究中,纳人安徽省二级及以上综合性公立医院ICU在2022年5月6日8:00至6月6日8:00的重症患者,收集基本信息、合并症、SOFA、APACHEII评分、化验检查和预后。确诊脓毒症患者随访28天,记录相关临床特点和预后指标。结果本研究共有安徽省16个市的53个中心重症医学科,期间纳人2255名患者,经过筛选后最终348名脓毒症患者纳人研究。其中SALI患者41人,非SALI患者307人,SALI占总脓毒症患者11.8%。SALI患者的平均年龄69.80±14.94,单因素分析中有统计学差异的参数有年龄、血气分析乳酸、二氧化碳分压、剩余碱、凝血酶原时间、纤维蛋白原、总胆红素、谷丙转氨酶、谷草转氨酶和24小时尿量等。将单因素有统计学意义的指标纳人logistic多因素分析,Logistic多因素分析计算得计算得出年龄OR0.732(95%CI0.436~0.846),P=0.028,乳酸OR-0.03(95%CI-0.07至-0.01),P=0.046和总胆红素OR0.89(95%CI-0.34至1.72),P=0.033。SALI和非SALI患者进行生存分析,生存分析显示SALI患者随着时间变化死亡率高于非SALI,Log-rank检验P<0.05,有统计学差异。结论安徽省多家医院脓毒症调查中SALI占总脓毒症患者11.8%。年龄、乳酸和总胆红素是影响SALI发生的独立危险因素,为脓毒症及脓毒症相关性肝损伤患者的诊治提供依据。Objective The aim of this study was to analyze the results of multiple Intensive care unit(ICU)in Anhui Province,China,to analyze the results of Sepsis-associated liver injury(SALI).Methods In this prospective,multicenter,observational study,criti-cally ill patients in ICUs of secondary and above comprehensive publichospitals in Anhui Province from 8:00 May 6 to 8:00 June 6,2022,were included,and basic information,comorbidities,SOFA,APACHE II scores,laboratory tests,and prognosis were collected.Patients with confirmed sepsis were followed up for 28 days,and relevant clinical characteristics and prognostic indicators were recorded.Results A total of 53 central intensive care departments in 16 cities in Anhui Province were included in this study,during which 2,255 patients were enrolled,and finally 348 patients with sepsis were included in the study after screening.There were 41 patients with SALI and 307 patients without SALI,and SALI accounted for 11.8%of the total sepsis patients.The mean age of SALI patients was(69.80±14.94)years and the parameters with statistically significant differences in univariate analysis were age,blood gas analysis lactate,partial pressure of carbon dioxide,residual alkalinity,plasma clotting time,fibrinogen,total bilirubin,valproic aminotransferase,valproic aminotransferase,and 24-hour urine output.Indicators that were statistically significant on a one-way basis were included in a logistic multifactor analysis,and logistic multifactor analysis calculated calculated age 0R 0.732(95%CI 0.436~0.846),P=0.028,lactate 0R-0.03(95%CI-0.07 to-0.01),P=0.046 and total bilirubin OR 0.89(95%CI-0.34~1.72),P=0.033.Survival analysis was performed in SALI and non-SALI patients,and survival analysis showed that mortality over time was higher in SALI patients than in non-SALI,with a statistically significant difference of P<0.05 by log-rank test.Conclusion SALI accounted for 11.8%of total sepsis patients in the sepsis survey of several hospitals in Anhui Province.Age,lactate and total bilirubin are in

关 键 词：脓毒症 毒症相关性肝损伤 患病率 危险因素 

分 类 号：R575[医药卫生—消化系统]