脓毒症并发胃肠道功能不全综合征死亡危险因素分析

Analysis of risk factors of death associated with gastrointestinal dysfunction Syndrome in septic patients

目的探讨脓毒症患者并发胃肠道功能不全综合征（GIDS）的影响预后的有关危险因素。方法回顾分析2011年10月～2012年10月间北京市海淀医院ICU收治的72例并发GIDS的脓毒症患者。GIDS为入选患者在ICU期间的病例资料中至少具有下列三项因素之一者：即肠内喂养不耐受（FI）、胃肠道出血（GIH）和麻痹性肠梗阻（PI）。记录其人口统计学和入选研究时的临床基本资料等25项指标,以及并发GIDS的基本情况,对上述资料先进行单因素分析,然后选择有统计学差异的因素进行多因素非条件Logistic回归分析。主要研究终点为ICU病死率。结果共有34例并发GIDS的脓毒症患者（47.2%）死亡,与存活组患者相比,非存活组患者病情更重（SOFA评分）（[7.76±3.6）v（s5.53±3.9）,P=0.003],ICU住院时间更长（[22.6±15.9）v（s15.0±10.0）,P=0.019）];Logistic回归分析结果显示,患者来源分类（OR=6.834,95%CI1.713~27.265,P=0.006）、血小板计数（PLT）（OR=2.01,95%CI2.004~2.017,P=0.002）是发生GIDS的脓毒症患者的独立死亡危险因素。结论脓毒症患者并发GIDS预后较差;来源手术科室和早期PLT降低的GIDS患者死亡风险较高。

【Objective】 To study risk factors of death associated with gastrointestinal dysfunction syndrome（GIDS） in septic patients.【Methods】 A retrospective analysis of adult GIDS patients with sepsis（n =72） admitted to ICU in Peking Haidian Hospital during the year 2012 was performed.GIDS was defined as documented gastrointestinal problems（food intolerance,gastrointestinal haemorrhage,and/or ileus） in the patient data at any period of their ICU stay.Twenty-five factors of the demographic characteristics,clinical information and data of the GIDS were recorded upon patient record.The primary end point was ICU mortality.Simple logistic regression was analyzed for all the risk factors and variables statistically significant were chosen for multivariate and unconditioned Logistic regression analysis.【Results】 The patient of death was identified in 34 patients（47.2% of all patients）.The prognosis of GIDS patients with sepsis was related to significantly higher SOFA score（7.76±3.6） vs（5.53±3.9）,in patients of survival,P =0.003）,as well as prolonged length of ICU stay（22.6±15.9）vs（15.0±10.0）,P =0.019）,respectively.The patients＇ profile（OR=6.834,95%CI1.713～27.265,P =0.006） and the decreased levels of PLT（OR=2.01,95%CI2.004～2.017,P =0.002） were independent risk factors of death for GIDS patients in sepsis.【Conclusion】 GIDS in patients with sepsis was associated with a significantly higher mortality,prolonged the ICU stay.Risk of death with the surgical patients,the decreased levels of PLT is higher in GIDS patients with sepsis.