影响监护室危重脓毒症患者预后的多因素分析

Analysis on multiple factors affecting prognosis in patients with severe sepsis in ICU

目的探讨影响ICU危重脓毒症患者预后的危险因素。方法回顾性分析该院重症医学科2005年1月至2015年1月严重脓毒症、脓毒症休克患者的临床资料,如基本资料、基础疾病及生化指标,按离开医院时的结局将其分为康复出院组和院内死亡组,通过非条件Logistic回归模型对相关因素进行多因素分析。结果共收治符合脓毒症诊断标准的患者2 587例,其中危重脓毒症968例(37.5%),男582例,女386例,年龄(45±12)岁,康复出院458例(47.3%),组间比较后发现院内死亡组年龄(58±26 vs.45±23,t=2.591,P=0.038)、APACHEⅡ评分(25±12.3 vs.16±8.5,t=2.346,P=0.032)、脓毒症休克比例(69.8%vs.40.6%,χ2=4.122,P=0.041)、2型糖尿病比例(1.1%vs.5.5%,χ2=8.106,P=0.036)、降钙素原(8.1±2.8 vs.2.5±5.3,t=3.681,P=0.041)及血清乳酸(5.2±2.5 vs.9.2±3.5,t=3.512,P=0.039)水平均高于康复出院组,但院内死亡组血清清蛋白(25±6.8 vs.34±8.5,t=3.212,P=0.035)水平低于康复出院组,多因素Logistic回归分析显示年龄、2型糖尿病、脓毒性休克、APACHEⅡ评分、降钙素原、血清乳酸及血清清蛋白水平是影响预后的独立危险因素(P<0.05)。结论年龄、2型糖尿病、脓毒性休克、APACHEⅡ评分、降钙素原、血清乳酸及血清清蛋白水平是影响危重脓毒症预后的高危因素。

Objective To investigate the risks factors affecting the prognosis in the patients with severe sepsis in ICU so as to provide th experience for increasing its treatment level. Methods The clinic data of patients With severe sepsis and septic shock in our hospital from January 2005 to January 2015 were retrospectively analyzed, including the general information, basic disease, biochemical indicators,the cases were divided into the recovery discharge group and intra-hospital death group according to the outcomes when leaving hospital. The related factors were performed the multivariate analysis by using the non-conditional Logistic regression model. Results A total of 2 587 sepsis patients were treated,among them 968 cases（37.5%） were severe sepsis,582 cases were male,aged （45 ± 12） years old,458 cases were cured and discharged, the inter-group comparison found that the age （58± 26 vs. 45±23,t=2.591,P=0.038 ）,APACHEⅡ score（25±12. 3 vs. 16±8. 5,t=2.346,P=0.032）,septic shock proportion （69.8 % vs. 40.6 %,χ^2= 4. 122, P = 0.041 ）, type2 diabetes proportion （ 1.1% vs. 5.5 %, χ^2 =8. 106, P= 0. 036 ）, procalcitonin （8.1±2.8 vs. 2. 5±5.3,t=3.681,P=0.041） and blood lactatelevel（5.2±2.5 vs. 9.2±3.5, t=3.512,P=0.039） in theintrahospital death group were higher than those in the recovery discharge group,but the serum albumin level（25±6.8 vs. 34±8.5 ,t=3. 212 ,P=0. 035） in the intra-hospital death group was lower than that in the recovery discharge group. The multiple factors Logistic regression analysis showed that the age, type2 diabetes, septic shock,APACHE Ⅱ score, procalcitonin,blood lactate and serum albumin were the independent risk factors affecting theprognosis（P〈0.05）. Conclusion Severe sepsis has higher incidence and higher motality. Age, stype2 diabetes, septic shock, APACHE Ⅱ score, procalcitonin, blood lactate and^serum albumin are the high- risk factors affecting the prognosis.