脓毒性脑病的预警因素分析(英文)

The predictive factors of septic encephalopathy

目的:研究脓毒性脑病(SE)和无脑病者(NE)的预警因素。方法:分析我院 ICU 2004.1-2006.9 收治的 117 例脓毒症病人的临床资料及相关检查结果,对比分析两组病人的住院时间、病死率、血培养、血压、白细胞计数(WBC)、血小板计数(PLT)、K +、Ca2+、游离钙(iCa2+)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白、球蛋白、总胆红素(TBIL)、直接胆红素(DBIL)、肌酐(SCr)、尿素氮(BUN) 、C 反应蛋白(CRP) 、血糖(BS) 、胆固醇、甘油三脂(TG) 、PaCO 2、CT/M RI、A PA CH EⅡ评分的差别。结果:52 例 SE 患者的A PA CH EⅡ评分、病死率、血培养阳性率、 A LT、A ST、SCr、BU N 、PaCO 2 与 65 例 N E 比较差异有统计学意义( P<0.05);鲍曼不动杆菌和金黄色葡萄球菌为脓毒症病人感染率最高的革兰阳性菌和阴性菌,分别为 18.49 % 和 13.70 % ,两组感染病原菌和感染率均不一样;10 例 SE 患者头部 CT/M RI有微小脓肿和组织水肿等阳性表现, 而 N E 组均无阳性表现;A PA CH EⅡ评分与脓毒症的病死率相关, 相关系数为 r=0.541, 而且两组病人 A PA CH EⅡ评分不同, 病死率也不一样,21-25 分段 SE 组病死率要高于 N E 组( P=0.001) 。结论:A PA CH EⅡ评分、血培养、A LT、A ST、SCr、BU N 、PaCO 2 对诊断和鉴别诊断 SE 具有重要意义, 调整 BS、SCr、A LT、BU N 、iCa2+、白蛋白水平对预防脓毒症发生 SE 有益。

Objective： To determine whether some predictive factors are existent in SE or not. Methods： A prospective observational cohort study was conducted in the intensive care unit （ICU） of XiangYa hospital of the Central South University. Within 31 mouths, a total of 117 patients with sepsis enrolled in the study who were divided to SE group （n=52） and nonencephalopathy group （NE, n=65 ）. The data of clinical characteristics, blood laboratory examination, pathogenicbacteria cultivation, and imaging examination were collected. The differences of two groups were contrastive analyzed. The predictive abilities of the predictive factors were evaluated： a rank spearman correlation was developed to predict the appearance of SE. Results： The incidence and the 28-day mortality of SE were 44.44 % and 63.46 %, and the mortality of SE was more than NE group patients（P=0.04 ）. Mann-Whitney U test showed a significant increased level of Acute Physiology and Chronic Health Evaluation （APACHE） II, blood urea nitrogen （BUN）, glutamate pyruvic transammase （GPT）, glutamic oxalocetie transaminase （GOP）, and infection of gam-positive cocci in SE in comparison with NE group （P〈0.05）. Computed tomography （CT） or magnetic resonance imaging （MRI） showed some imaging abnormalities in SE patients. The spearman text showed the rank correlation coefficients of the predictive factors were APACHE II score （r=0.455, P〈0.01 ）, GPT （r=0.332, P〈0.01 ）, GOT （r=0.313, P〈0.01 ）, BUN（r=0.264, P=0.04）, Gram positive cocci infection （r=0.238, P=0.43 ）. Conclusion： Sepsis associated encephalopathy is common and often severe. The predictive factors correlated with the encephalopathy remind us of precautions： Gram positive cocci infections, and elevated levels of APACHE Ⅱ scores, BUN and GPT, GOP. A large sample, multicenter, multifactor study is needed to determine the risk factors for SE in future.