脓毒性休克患者急性静脉血栓栓塞的危险因素及预后

Analysis of the risk factors of acute venous thromboembolism and prognosis of patients with septic shock

目的探讨脓毒性休克患者急性静脉血栓栓塞(VTE)的危险因素及预后。方法选取116例脓毒性休克患者为研究对象,统计VTE的发病情况,采用单因素和Logistic多因素分析法分析脓毒性休克患者发生VTE的危险因素,比较不同VTE发生情况患者的APACHEⅡ评分和预后情况,并采用Spearman秩相关分析法分析脓毒性休克患者VTE发生率与其APACHEⅡ评分和预后的关系。结果 VTE的发生率为37.07%(43/116),且与无VTE患者比较,发生VTE患者的年龄较大、住院和机械通气时间较长、气管插管率提高,差异有统计学意义(P<0.05)。进一步Logistic多因素分析法分析结果显示,住院时间、机械通气时间及气管插管率均为脓毒性休克患者VTE的独立危险因素。VTE患者治疗前后的APACHEⅡ评分及28 d病死率均高于无VTE患者(P<0.05)。Spearman秩相关分析结果显示,脓毒性休克患者VTE的发生及APACHEⅡ评分与28 d病死率均呈正相关(r=0.748、0.856,P<0.05)。结论脓毒性休克患者VTE的发病率较高,且住院时间、机械通气时间及气管插管率均为其独立危险因素,脓毒性休克患者发生VTE及病情均与预后相关。

Objective To explore the risk factors of acute venous thromboembolism（VTE） in patients with septic shock, and the relationship of VTE with APACHEII scores and prognosis. Methods 116 patients with septic shock in our hospital from January 2012 to January 2013 were selected as the research objects and the occurrence of VTE among them were statistically analyzed. Single factor analysis and Logistic multiple factors analysis were applied in the analysis of risk factor of VTE of patients with septic shock. APACHEII scores and prognosis of patients with or without VTE were compared and Spearman rank correlation was applied in analysis of relationship between VTE incidence with APACHEII scores and prognosis of patients with septic shock. Results VTE incidence of 116 patients with septic shock was 37.07%（43 / 116）, and compared with patients without VTE, patients with VTE had older age, longer hospital stay and mechanical ventilation time, and higher endotracheal intubation rate, thus age, length of hospital stay, mechanical ventilation time and tracheal intubation rate were related factors of VTE of patients with septic shock（P〈0.05）. Further Logistic multiple factors analysis results showed that the length of hospital stay, mechanical ventilation time and rate of tracheal intubation were independent risk factors for VTE of septic shock patients. APACHEII scores of patients with VTE before and after treatment and 28 d mortality were higher than those of septic shock patients without VTE（P〈0.05）. Spearman rank correlation analysis results showed that VTE incidence of patients with septic shock was positively correlation with APACHEII score and 28 d mortality rate（r=0.748, 0.856, P〈0.05）.Conclusion VTE incidence of septic shock patients was higher and the length of hospital stay, mechanical ventilation time and rate of tracheal intubation were independent risk factors for VTE of patients with septic shock, and VTE incidence of septic shock patients was related to its prognosis, thus reducing endotracheal intubation, shorten the length of hospital stay and mechanical ventilation time were advantageous to the prevention of VTE in patients with septic shock and the improvement of prognosis. Septic patients with VTE need to be alert to worsen of disease and poor prognosis and should take timely intervention measures to improve prognosis.