脓毒症呼吸衰竭患者急性胃肠损伤危险因素分析

The risk factors of acute gastrointestinal injury of sepsis patients with respiratory failure

目的探讨脓毒症呼吸衰竭患者发生急性胃肠损伤（acute gastrointest inalinjury，AGI）的危险因素。方法采用前瞻性观察性研究方法，选择2016—04—2017—02河南省人民医院呼吸重症监护病房（RICU）收治的116例脓毒症呼吸衰竭患者为研究对象，收集患者临床和实验室化验检查结果，计算患者序贯脏器衰竭评分（SOFA评分）、氧合指数（PaO2／FiO2）、格拉斯哥昏迷评分（GCS），记录急性胃肠损伤（AGI）症状，根据患者是否存在AGI症状进行分组，比较不同组患者各项临床资料的差异，Logistics回归分析筛选影响患者胃肠功能的危险因素。结果116例脓毒症呼吸衰竭患者共有71例（61．2％）发生AGI，AGIⅠ、Ⅱ、Ⅲ、Ⅳ级发生率构成比依次为50．7％、28．2％、15．5％、5．6％。AGI组患者PaO2／FiO2、ALB水平、GCS评分低于非AGI组，PCT、CRP、血糖、SOFA评分高于非AGI组；多因素Logistic回归分析显示，ALB、血糖、CRP、GCS评分、PaO2／FiO2是脓毒症呼吸衰竭患者发生AGI的独立危险因素（P〈0．05）。结论脓毒症呼吸衰竭患者AGI发生率高，ALB、CRP、血糖、GCS评分、PaO2／FiO2是预测脓毒症呼吸衰竭患者发生AGI的独立危险因素。

Objective To investigate the risk factor of acute gastrointestinal injury （AGI） of sepsis patients with respiratory failure. Methods A prospective observational study involving 116 sepsis patients with respiratory failure in Respiratory Intensive Care Unit （RICU） of Henan Provincial People＇s Hospital from April 2016 to February 2017 were conducted. Clinical and laboratory variables were col- lected. Sequential organ failure assessment （SOFA） score, oxygen index （PaOE/FiO2 ） , Glasgow Coma Scale （GCS） were calculated. The symptoms of AGI were recorded. Patients were grouped according to the symptoms of AGL The data between the two groups were compared respectively; Logistic regression analysis was used to determine the independent predictor for gastrointestinal function. Results Among the 116 sepsis patients with respiratory failure, AGI was identified in 71 patients （61.2%）. The proportion of grade Ⅰ、Ⅱ、Ⅲ、Ⅳ of AGI was. 50.7% , 28.2% , 15.5%, 5.6%. Compared with Non - AGI group, the patients in AGI group showed lower oxygen index, the level of plasma albumin, GCS score, but higher levels of CRP, blood glucose, SOFA score. It was identified by Logistic regression that the plasma albumin level, CRP, blood glucose, GCS score and oxygen index were risk factors of AGI in sepsis patients with respiratory failure （ P 〈 0.05 ）. Conclusion The incidence of AGI among sepsis patients with respiratory failure was high. Albumin, CRP, blood glucose, GCS score and PaO2/FiO2 were independent risk factors for AGI in sepsis patients with respiratory failure.