大面积烧伤并发脓毒症的独立危险因素

Independent risk factors for sepsis in patients with large area burns

目的探讨大面积烧伤患者发生脓毒症的独立危险因素。方法收集2014年6月-2015年6月收治的大面积烧伤患者307例，观察年龄、性别、伤后就诊时间、急诊焦痂切开、烧伤指数、休克期切削痂手术、休克期延迟复苏、氧分压（PaO2）、二氧化碳分压（PCO2）、辅助通气方式、机械通气时间、吸人性损伤、预防性气管切开、持续性乳酸升高、顽固性高钠血症、心肺疾患病史、糖尿病史等相关变量及其与患者发生脓毒症的相关性，将具有统计学意义的变量纳入二分类非条件Logistic回归分析，筛查出与大面积烧伤患者并发脓毒症相关的独立危险因素。结果休克期延迟复苏（OR=1．747，95％CI1．822～7．431，P〈0．05）、持续性乳酸升高（OR=1．758，95％CI1．137-4．002，P〈0．05）、顽固性高钠血症（OR=2．985，95％CI1．074—6．782，P〈0．05）、中重度吸人性损伤（OR=14．764，95％C10．892～47．323，P〈0．05）及烧伤指数（OR=5．017，95％C11．075—23．572，P〈0．05）是大面积烧伤患者并发脓毒症的独立危险因素。结论对于大面积烧伤患者发生脓毒症的独立危险因素应进一步重视，早期及时采取积极治疗措施，有利于减少脓毒症的发生。

Objective To determine the independent risk factors for sepsis in patients with large area burns. Methods The study enrolled 307 patients with large area burns treated from June 2014 to June 2015. Related variables included age, gender, visit time, emergency eschar open, burn index, tangential excision of eschar during shock stage, delayed resuscitation during shock stage, oxygen pressure（PaO2 ）, carbon dioxide pressure （PaCO2 ）, assisted ventilation mode, mechanical ventilation time, inhalation injury, prophylactic tracheotomy, continuous lactic acid rise, refractory hypernatremia, heart-lung disease history, and diabetes history. Correlation of the variables with the incidence of sepsis was observed. Independent predictors of sepsis in patients with large burns were differentiated using the Logistic regression analysis. Results Delayed resuscitation during shock period （ OR = 1. 747, 95% CI1.822-7,431, P 〈0.05）, continuous lactic acid rise （OR = 1.758, 95%CI 1. 137 -4.002, P 〈 0.05 ） , refractory hypernatremia （ OR = 2. 985, 95% CI 1. 074 - 6. 782, P 〈 0.05 ） , moderate and severe inhalation injury（ OR = 14. 764, 95% CI 0. 892 -47. 323, P 〈 0.05 ） and burn index （OR =5. 017, 95% CI 1. 075 - 23. 572, P 〈 0.05 ） were found be independently associated with sepsis in patients with large burns. Conclusions These independent risk factors for sepsis in large area burn patients deserve more attention. Early and timely treatment measures may reduce the incidence of sepsis.