脓毒症患者死亡危险因素分析

Analysis of the risk factors of death in the patients with sepsis

目的探讨脓毒症患者死亡的相关危险因素。方法调查分析本院2004-01～2006-12急诊病房118例脓毒症死亡患者临床资料,行Logistic多因素分析。结果符合脓毒症诊断标准260例,病死率45.4%(118/260)。男性与女性患者年龄、APACHEⅡ评分和病死率比较差异均无统计学意义(P>0.05);≥60岁组病死率高于<60岁组(P<0.05);严重脓毒症病死率66.0%(105/159),MODS病死率77.2%(78/101),脓毒性休克病死率83.6%(61/73);脏器功能障碍>3个病死率91.3%(42/46);伴急性肾功能衰竭病死率96.0%(24/25),APACHEⅡ评分≥20分病死率61.2%(104/170)。Logistic多因素分析提示,脓毒症死亡危险因素OR大小依次是伴急性肾功能衰竭、老龄、脓毒性休克、MODS、严重脓毒症、APACHEⅡ评分≥20分、高血糖。结论脓毒症有较高的病死率,老龄、严重脓毒症、MODS、脓毒性休克、伴急性肾功能衰竭、APACHEⅡ评分≥20分和高血糖是脓毒症死亡的高危因素。

Objective To investigate the risk factors of death in the patients with sepsis.Methods The clinical data of the 118 septic patients who died from January 2004 to December 2006 were studied by Logistic multiple regression analysis.Result The 260 cases satisfied diagnostic criteria of sepsis.The total mortality was 45.4%.The age,APACHEⅡ score and mortality were not significantly different between men and women in patients with sepsis（P〉0.05）.The mortality of sepsis were higher in the patients aged more than 60 years old than in those aged below 60 years old（P〈0.05）;The mortality of severe sepsis,multiple organ dysfunction syndrome,septic shock,more than three failing organs and acute renal failure with sepsis,APACHEⅡ score ≥20 were 66.0%,77.2%,83.6%,91.3%,96.0% and 61.2%.Logistic multiple regression analysis showed that OR of the risk factors were higher in the patients of acute renal failure,elder age,septic shock,multiple organ dysfunction syndrome,severe sepsis,APACHEⅡ score≥20 and high blood glucose in order.Conclusion The sepsis-related death was still very high.The patients of sepsis with elder age,severe sepsis,multiple organ dysfunction syndrome,septic shock,acute renal failure,APACHEⅡ≥20 score and high blood glucose were significantly associated with sepsis-related death.