脓毒症合并急性胃肠损伤的危险因素分析

A investigation about the risk factors for sepsis with acute gastrointestinal injury （AGI）

目的探讨脓毒症并发急性胃肠损伤（AGI）的危险因素。方法回顾分析2012-09～2014—09于上海市同济医院和上海市利群医院急诊监护室（EICU）住院治疗的脓毒症患者（合并或未合并AGI）100例，总结分析其病因、临床特点，探讨脓毒症发生AGI的危险因素。结果脓毒症患者100例，年龄（77．4±14．4）岁，男性55例（55．0％），女性45例（45．0％）。AGI53例（53．0％）。72h内死亡2例。AGⅡ、Ⅱ、Ⅲ、Ⅳ级发生率构成比依次为52．8％、30．2％、13．2％、3．8％。胃肠衰竭（AGIⅢ＋Ⅳ级）比例17．0％。AGI组与非AGI组年龄、性别构成比较差异无统计学意义（P〉0．05）。两组慢性心力衰竭比例比较差异有统计学意义（50．9％VS．25．5％，P〈0．05）。两组生化指标（肝肾功能、肌钙蛋白、乳酸）比较差异无统计学意义（P〉0．05）。AGI组ICU住院天数多于非AGI组[（10．8±4．63）dVS．（7．62±3．22）d，P=0．003]，MODS发生率、危重评分高于非AGI组[28．3％VS．4．3％，（22．32±4．18）分VS．（16．87±3．90）分，P〈0．05]。两组感染指标（白细胞计数、PCT水平）比较差异有统计学意义[（13．7±7．32）×10^9／LVS．（10．50±5．25）×10^9／L，（17．48±29．90）vs．（5．06±14．67）分，P〈0．05]。Logistic回归分析显示，慢性心力衰竭、低血压是脓毒症发生AGI的危险因素。结论AGI在脓毒症患者发生率较高，慢性心力衰竭、低血压是脓毒症发生AGI的危险因素。

Objective To explore the risk factors for sepsis with acute gastrointestinal injury （AGI）. Method Retrospectively analyzed 100 patients with sepsis （with or without AGI）who were hospitalized in EICU of Shanghai Tongji hospital and Shanghai Liqun Hospital. The causes of sepsis, clinical characteristics, risk factors for AGI were analyzed. Results There were 100 patients with sepsis, the age was（77.4 ± 14.4） y, the males was 55 （55.0%）, the female was 45 （45.0%）. 2 patients died in 72 hours. The proportion of grade Ⅰ ,Ⅱ, Ⅲ, Ⅳ of AGI was： 52.8%, 30.2%, 13.2% ,3.8%. The proportion of gastrointestinal failure （ AGI of grade III, IV ） was 17.0%. Therewas no significant diffidence about age, gender between AGI group and No - AGI group （ P 〉 0.05 ）. The hospital stay of AGI group was longer than No - AGI group （ P 〈 0.05 ）. The proportion of MODS and APACHE Ⅱ scores of AGI group was more than No - AGI group （ P 〈 0.05 ）. Therewas no significant diffidence about blood biochemical indicators （ the hepatorenal function and the serous level of cTnI and lactate） between AGI group and No - AGI group （ P 〉 0.05 ）. There was significant diffidence about WBC count, the level of PCT between AGI group and No - AGI group （P 〈 0.05 ）. According to Logistic analysis, heart failure and low blood pressure were risk factors for sepsis with AGI. Conclusion The incidence of AGI among patients with sepsis was high. Heart failure and low blood pressure were risk factors for sepsis with AGI.