ICU重度脓毒症的流行病学特点及预后影响因素的分析

Epidemiological characteristics of severe sepsis in ICU and influencing factors for prognosis

目的探讨重症监护病房重度脓毒症的流行病学特点及影响预后的相关因素。方法采用回顾性研究方法,对医院2016年2月-2017年11月ICU收治的72例重度脓毒症患者的临床资料进行收集,选用Logistic回归分析的统计方法。对重度脓毒症的流病学特点及死亡影响因素进行分析。结果 72例重度脓毒症患者中,41例发生脓毒症性休克,死亡17例,院内获得性感染51.4%,分离病原菌中以革兰阴性菌为主占46.7%,常见感染部位依次为呼吸道、胃肠道及腹腔、血流感染,以患者3个月的预后情况为因变量,将年龄、APACHEⅡ评分、器官衰竭数、脓毒症性休克、血管活性药物应用、院内获得性感染、中枢神经系统功能不全引入Logistic回归方程,结果显示,年龄、器官衰竭数目、脓毒症休克、院内获得性感染为重度脓毒症患者死亡的独立影响因素。结论重度脓毒症患者合并高龄、院内获得性感染、多器官衰竭及脓毒症性休克者,预后不良。

OBJECTIVE To explore the epidemiological characteristics of severe sepsis in intensive care unit（ICU）and analyze the influencing factors for prognosis.METHODS By means of retrospective survey,the clinical data were collected from 72 patients with severe sepsis who were treated in ICU from Feb 2016 to Nov 2017,logistic regression analysis was carried out for statistical analysis,and the epidemiological characteristics of the severe sepsis and influencing factors for death were observed.RESULTS Of the 72 patients with severe sepsis,41 had septic shock,17 died,51.38% had hospital-acquired infections.Among the isolated pathogens,the gram-negative bacteria accounted for 46.7%.Respiratory tract,gastrointestinal tract,abdominal cavity and blood were the common infection sites.The 3-month prognosis was set as the dependent variable,the age,APACHEⅡ score,number of organ failure,septic shock,use of vasoactive drugs,hospital-acquired infections and dysfunction of central nervous system were introduced into logistic regression equation,and the result indicated that the age,number of organ failure,septic shock and hospital-acquired infections were the independent influencing factors for the death of the patients with severe sepsis.CONCLUSIONThe severe sepsis patients complicated with advanced age,hospitalacquired infections,multiple organ failure and septic shock have the poor prognosis.