不同来源感染性休克临床特征和预后影响因素

CLINICAL FEATURES AND PROGNOSTIC FACTORS OF SEPTIC SHOCK CAUSED BY DIFFERENT SOURCES

目的探讨不同感染来源的感染性休克临床特征和预后影响因素。方法对2011～2014年广州市花都区人民医院重症医学科（ICU）收治的205例感染性休克患者进行回顾性分析，根据感染来源分为内科感染组和外科感染组，比较其临床特征，对影响28天病死率的因素进行Logistic回归分析。结果ICU感染性休克病例占比8．1％。内科感染组159例，以肺部感染（83．0％）为主；外科感染组46例，以腹腔感染（78．3％）为主。两组比较：年龄、发病季节、早期目标导向治疗（EGDT）达标时间均无统计学差异（P〉0．05）；急性生理和慢性健康状况评分（APACHEII）和神经、心血管、呼吸系统疾病患病率均有显著差异（P〈0．01）；性别、器官衰竭数目有统计学差异（P〈0．05）。两组28天内总病死率为42．9％（分别为42．8％和43．5％），组间比较无统计学差异（P〉0．05）。Logistic回归分析结果显示，器官衰竭数目[OR=2．154，95％CI（1．451，3．198）]、EGDT7～24h内达标[OR=13．751，95％CI（5．727，33．017）]、24h内未达标[OR=16．544，95％CI（6．317，43．330）]为28天内死亡的独立危险因素，均有显著差异（P〈0．001）。对感染灶进行急诊外科处理为独立保护因素[OR=0．091，95％CI（0．017，0．499），P〈0．01]。结论不同感染来源感染性休克的临床特征不同。器官衰竭数目多、EGDT未在6h达标者28天内死亡风险高，对感染灶实施急诊外科处理的死亡风险低。感染来源对感染性休克28天病死率无独立影响。

Objective To explore the clinical features and prognostic factors of septic shock caused by dif- ferent sources. Methods 205 septic shock patients admitted to the Intensive Care Unit （ICU） of our hospital from 2011 to 2014, in the retrospective study, were divided into the medication- sourced infection group and the surgery- sourced infection group according to the sources of infection. The clinical features were compared. The factors of 28 - day mortality were analyzed by Logistic regression analysis. Results Septic shock cases in the ICU accounted for 8. 1%. There were 159 cases in the medical - infected group, with the majority of lung infection （83.0%）. There were 46 cases in the surgical - sourced infeciton group, with a majority of abdominal infection （78.3%）. There were no statistical differences in the age, onset season and standard time of early goal - directed therapy （EGDT） of the two groups（p 〉0.05）. There were significant differences in the Acute Physiology and Chronic Health Evaluation II （APACHE II）, and the morbidity rates of nerve, cardiovascular and respiratory system diseases （p 〈 0.01 ）. There were statistical differences in both gender and the number of organ failure （p 〈 0.05 ）. The 28 - day mortality of the two groups was totally 42.9% （42.8% , 43.5%, respectively）, with no statistical difference between the two groups （p 〉0.05）. The result of Logistic regression analysis showed that, the number of organ failure [ OR =2. 154, 95% CI （1. 451, 3. 198） ] , EGDT achieving the curative targets within 7 - 24 hours [ OR = 13. 751, 95% CI （5. 727, 33.017 ） ], EGDT achieving no curative target within 24 hours [ OR = 16. 544,95 % CI （ 6.317, 43. 330 ） ] were the independent risk factors for death within 28 days, with respectie significant differences （p 〈 0.001 ）. The emergency surgical treatment for affected sites was independent protective factor [ OR = 0. 091, 95% CI （0.017, 0.499）, p 〈 0. 01 ]. Conclusion The clinical features of septic shock caused by different sources are not the same. The multi - organ failures and achieving no curative target by EGDT within 6 hours are high risks for death within 28 days, while those undergoing emergency surgical treatments for the affected sites is of low risk for death. The sources of infection have no independent effects on 28 - day mortality of septic shock cases.