脓毒症合并急性胃肠损伤的危险因素与预后调查分析

Risk factors of occurrence and prognosis of acute gastrointestinal injury in patients with sepsis

目的探讨脓毒症并发急性胃肠损伤(acute gastrointestinal injury,AGI)的危险因素及与预后相关的危险因素。方法 2012年9月至2014年9月于同济大学附属同济医院急诊监护室住院治疗的脓毒症患者,62例合并AGI,49例无AGI。总结分析其病因、临床特点以及发生AGI及预后相关的影响因素。结果脓毒症患者111例,年龄(77.38±14.28)岁,男性62例(55.9%),女性49例(44.1%)。AGI 62例(55.9%)。72 h死亡3例。AGIⅠ、Ⅱ、Ⅲ、Ⅳ级发生率构成比依次为:53.2%,29.0%,14.5%,3.3%。AGI组与非AGI组年龄、性别构成、APACHEⅡ评分差异无统计学意义(P>0.05)。AGI组ICU住院天数多于非AGI组,M ODS发生率、机械通气比例明显高于非AGI组,AGI组患者PCT、ALT、c Tn I、乳酸水平明显高于非AGI组,AGI组体液免疫指标(IL-4、IL-6)明显高于非IGI组(P<0.05)。恶化组与非恶化组比较:白细胞、PCT、CRP水平差异无统计学意义(P>0.05)。ICU住院天数延长,男性患者、低血压、M ODS、AGI比例较高,危重评分、血乳酸、AST、BUN、体液免疫指标(IL-2、IL-4、IL-6)水平较高(P<0.05)。Logistic回归分析显示:心力衰竭、低血压、M ODS是脓毒症发生AGI的危险因素,男性是脓毒症预后不佳的危险因素。结论急性胃肠损伤在脓毒症患者发生率较高,临床医生需关注其危险因素,提前干预。

Objective To investigate the risk factors of occurrence and prognosis of acute gastrointestinal injury（ AGI） in patients with sepsis. Methods Clinical data of 111 patients with sepsis admitted in EICU of Tongji Hospital,Tongji University,including 62 with AGI and 49 without AGI,were retrospectively reviewed. The causes of sepsis,clinical characteristics,risk factors for AGI and prognosis of sepsis with AGI were analyzed. Results The mean age of patients was（ 77. 38 ± 14. 28） years,and 62 were males（ 55. 9%） and 49 were females（ 44. 1%）. Among 62（ 55. 9%） septic patients with AGI 3 died in 72 h. The proportion of gradeⅠ,Ⅱ,Ⅲ and Ⅳ of AGI was 53. 2%,29. 0%,14. 5% and 3. 3%. There was no significant difference in age,gender and APACHEⅡ scores between AGI and No-AGI groups（ P 〉0. 05）.The length of hospital stay of AGI group was longer than that of non-AGI group（ P 〈0. 05）. The proportion of multi-organ dysfunction syndrome（ MODS） and mechanical ventilation in AGI group was higher than that of No-AGI group（ P 〈0. 05）. The serum levels of PCT,c Tn I,ALT and lactate in AGI group was higher than those in non-AGI group（ P 〈0. 05）. The serum levels of IL-4 and IL-6 in AGI group were higher than those in non-AGI group（ P 〈0. 05）. There was no significant diffidence in WBC count,PCT and CRP levels between poor-prognosis group and No-poor-prognosis group（ P 〉0. 05）. The length of hospital stay in poor-prognosis group was longer than that of no-poor-prognosis group（ P 〈0. 05）. The proportion of male,lowblood pressure,MODS and mechanical ventilation in poorprognosis group was higher than that in no-poor-prognosis group（ P 〈0. 05）. The APACHEⅡ scores and the serum levels of PCT,AST,lactate,BUN,IL-2,IL-4,IL-6 of poor-prognosis group was higher than those of no-poor-prognosis group（ P 〈0. 05）. Logistic Analysis showed that heart failure,MODS and lowblood pressure were risk factors for AGI in septic patients,and male gender was the risk factor for poor prognosis of septic patients with AGI. Conclusion The incidence of AGI among patients with sepsis is high,to understand the risk factors of AGI would be beneficial to prevent its occurrence in septic patients.