ICU老年病人腹腔感染致感染性休克的临床分析

Clinical features of elderly ICU patients with septic shock due to intra-abdominal infection

目的：分析外科ICU老年腹腔感染致感染性休克病人的临床特点。方法：回顾性分析2014年1月至12月外科ICU收治的腹腔感染致感染性休克病人,分为老年组（≥65岁）与非老年组（〈65岁）,比较两组病人基础疾病、入科时APACHEⅡ评分、继发脏器损伤、去甲肾上腺素使用时间与剂量、机械通气时间、ICU住院时间及死亡等临床特征。结果：老年组入科APACHEⅡ评分、降钙素原水平、心脏基础疾病、急性呼吸功能障碍、急性肾损伤2-3期或需要连续肾替代治疗治疗和多脏器功能障碍综合征的发生率,机械通气时间、去甲肾上腺素使用时间与日均剂量及死亡率均显著高于非老年组（P〈0.05）。老年组高血压、慢性阻塞性肺疾病与糖尿病的患病率、急性心衰/心律失常及住ICU时间高于非老年组,但无统计学差异（P〉0.05）。结论 ：腹腔感染导致感染性休克的老年病人,更容易发生急性呼吸功能障碍和急性肾损伤,休克难以纠正,死亡率高。

Objective To analyze the clinical features of septic shock due to intra-abdominal infections of the elderly patients in surgical intensive care unit（ICU）. Methods The patients with septic shock due to intra-abdominal infections admitted in surgical ICU during 2014 were analyzed retrospectively and were divided into elderly group（≥65） and non-elderly group（〈65）. The clinical features of patients including chronic disease, APACHE Ⅱ score, secondary organ dysfunction, norepinephrine duration and dose requirements, mechanical ventilation time, length of ICU stay and mortality were compared with between 2 groups. Results The clinical parameters of the patients in elderly group including APACHEⅡ score, procalcitonin, chronic heart disease, acute respiratory dysfunction, acute kidney injury stag 2-3 or need continuous renal replacement therapy, incidence of multiple organ dysfunction, duration of mechanical ventilation, duration and daily dose of norepinephrine and mortality were significantly higher than those in non-elderly group（P〈0.05）. There was no difference in the other clinical parameters including incidence of hypertension, chronic obstructive pulmonary disease and diabetes, incidence of acute heart failure or arrhythmia and ICU stay between 2 groups（P〉0.05）. Conclusions The elderly patients with septic shock due to intra-abdominal infections were prone to acute respiratory dysfunction, acute kidney injury, intractable shock and higher mortality.