危重型肾综合征出血热临床状况的分析(非条件Logistic模型)

An analysis of patient's clinical condition of hemorrhagic fever with renal syndrome:an unconditional logistic regression model/

目的：找出影响肾综合征出血热（ＨＦＲＳ）病情转归的危重征象，以供临床医生参考，予以及时处理，以达降低ＨＦＲＳ的病死率。方法：运用多因素非条件Ｌｏｇｉｓｔｉｃ回归分析，对９６例危重型和１０２例非危重型ＨＦＲＳ的临床资料进行分析。结果：认为急性呼吸窘迫综合征（ＡＲＤＳ），外周血小板计数，意识改变，少尿期长短，消化道大出血和颅内出血对本病严重程度的判断有价值；未发现性别、年龄和入院时病程与病情轻重有关。结论：影响ＨＦＲＳ病情轻重的主要因素是其并发症。要阻断ＨＦＲＳ患者病情的发展，必须立足于早期诊断和合理治疗，尽最大可能纠正机体代谢失衡，维持内环境稳定，防止腔道和颅内出血，预防继发感染，改善肾功能和强心利尿是降低危重型ＨＦＲＳ病死率的有效措施。

Objective:To determine factors related to patient's clinical condition of hemorrhagic fever with renal syndrome (HFRS) and improve successful rate of clinical treatment.Methods:In this study,the patient's clinical conditions were analyzed in 96 very severe cases (case) and 102 milder cases (control) of HFRS by multivariate unconditional logistic regression analysis.Results:It was shown that following factors were valuable for discriminating severity of the disease:acute respiratory distress syndrome (ARDS),blood platelet count,mentality disorders,prolonged oliguric stage,severe bleeding of the gastrointestinal tract and intracranial hemorrhage.No marked correlations were found between patients,sex,age,course of disease at admission and severity of HFRS.Conclusions:Our data suggest that major factors affecting the severity of HFRS are clinical complications.In order to abate the development of HFRS and reduce the mortality rate,it is very important to make early diagnosis and give rational treatment,including correcting metabolic disorder,preventing intestinal and intracranial bleeding,as well as secondary infection,and improving renal and/or cardiac function.