重症监护病房419例重度脓毒症患者的临床分析

The clinical analysis of 419 severe sepsis patients in intensive care unit

目的 探讨综合重症监护病房（ICU）重度脓毒症的流行病学特点及其死亡危险因素.方法 采用回顾性研究方法,选取2009年1月至2012年12月北京友谊医院ICU收治的419例重度脓毒症患者,对其临床资料进行收集与统计,分析临床特征,采用logistic回归分析明确重度脓毒症死亡的独立危险因素.结果 重度脓毒症的ICU病死率为43.9％（184/419）;感染部位以呼吸道（50.8％）、胃肠道及腹腔（27.8％）、血流感染（4.3％）为主；革兰阴性菌为最常见致病菌[46.0％ （214/465）]；在纳入研究的重度脓毒症患者中院内获得性感染约占53.7％（225/419）.Logistic回归分析显示：年龄[优势比（OR）=0.003,95％可信区间（95％CI）为1.015～1.056,P=0.000]、血管活性药物应用（OR=3.251,95％CI为1.562～6.768,P=0.002）、器官功能衰竭≥3个（OR=2.452,95％CI为1.015 ～ 5.924,P=0.046）、院内获得性感染（OR=1.775,95％ CI为0.981～3.221,P=0.046）为重度脓毒症患者死亡的独立危险因素.结论 重度脓毒症是ICU收治患者中的常见疾病,合并死亡危险因素的重度脓毒症患者应给予更为密切的监测和积极的治疗.

Objective To investigate the epidemiological characteristics and mortality risk factors of severe sepsis patients admitted into intensive care unit （ICU）. Methods The clinical data of 419 severe sepsis patients admitted to an adult ICU of Beijing Friendship Hospital from January 2009 to December 2012 were retrospectively analyzed and evaluated. Logistic regression analysis was employed to identify independent risk factors for the death of patients with severe sepsis during ICU stay. Results Overall ICU mortality was 43.9% （184/419）, and the respiratory tract was the most common site of infection （50.8%）, followed by infection of the gastrointestinal tract and abdominal cavity （27.8%）, and hematogenous infection （4.3%）. Gram-negative bacteria were the most common pathogens [46.0% （214/465）]. Iatrogenie infections accounted for 53.7% （225/419） of the enrolled patients. Logistic regression analysis showed that age [odds ratio （OR）=0.003, 95% confidence interval （95%CI） 1.015-1.056, P=0.000], vasoactive drug application （ OR = 3.251, 95%CI 1.562-6.768, P= 0.002 ）, failure of 3 or more organs （ OR = 2.452, 95%CI 1.015-5.924, P=0.046）, and iatrogenic infection （OR=1.775, 95%CI 0.981-3.221, P=0.046） were independent risk factors for ICU mortality. Conclusions Severe sepsis is a common cause of ICU admission. Patients with risk factors for high mortality should he carefully monitored, and aggressive treatment should be administered.