吻合口瘘并发脓毒症休克危险因素分析

Risk factor analysis of septic shock following anastomotic leak

目的：探讨吻合口瘘患者并发脓毒症休克的危险因素。方法回顾性分析2008年1月至2014年7月于我科接受腹部大手术治疗后发生吻合口瘘患者的临床资料，根据是否并发脓毒症休克将患者分为脓毒症休克组和非脓毒症休克组，比较组间相关指标的差异，多因素回归分析探讨吻合口瘘并发脓毒症休克的危险因素。结果脓毒症休克组患者 APACHEⅡ评分较高，合并基础疾病、恶性疾病、输血等情况更为多见，平均动脉压较低，胰肠吻合比例较高，菌血症、MODS 发生率较高，住院时间较长，组间差异有统计学意义（P 均＜0．05）。多因素 Logistic 回归结果显示，恶性疾病、COPD／肝脏基础疾病、输血、菌血症、结肠-结肠吻合口瘘以及 APACHEⅡ评分＞15是吻合口瘘患者可能发生脓毒症休克的独立危险因子（OR 值均＞1．0，P ＜0．05）。结论恶性疾病、COPD／肝脏基础疾病、输血、菌血症、结肠-结肠吻合口瘘以及 APACHEⅡ评分＞15是吻合口瘘患者发生脓毒症休克的危险因素。

Objective To investigate the risk factors of septic shock following anastomotic leak. Methods The clinical data of patients accepted major abdominal surgery in our department from January 2008 to July 2014 were collected and analyzed retrospectively.Enrolled patients were divided into septic shock group and non-septic shock group.The differences of related indicators were compared between the two groups and multivariate analysis were performed to find the risk factors of septic shock following anas-tomotic leak.Results High APACHEⅡ score,underlying diseases,malignant diseases,blood transfusion, low mean arterial pressure,pancreaticojejunostomy,incidence of bacteremia and MODS and long hospital stay were more common in patients with sepsis shock.Multivariable logistic regression analysis identified malignancy,chronic obstructive pulmonary disease（COPD）,liver diseases,blood transfusion,bacteremia, colonic anastomosis fistula,and APACHE II score 〉 15 as significant independent predictors of septic shock in patients with anastomotic leak（OR 〉1.0,P 15 are independ-ent predictors for septic shock in patients with anastomotic leak.