重症感染毛细血管渗漏综合征相关危险因素的临床研究

Clinical Study of Risk Factors Related to Capillary Leak Syndrome in Severe Infection

探讨重症感染毛细血管渗漏综合征(capillary leak syndrome, CLS)相关危险因素。方法整群选择2005年1月-2017年1月收治的6 690例重症患者病历资料,其中出现CLS的患者482例,按疾病治疗情况将上述患者分为A、B、C 3组,其中A组均为治愈患者(324例),B组为死亡患者(97例),C组为未愈出院患者(61例),并对3组患者进行CLS危险因素分析。结果 A组入院时的CVP、PAHR、AG、氧合指数、甘油三酯、白蛋白及血清总蛋白分别为A组入院时的CVP(11.03±2.25)cmH2O、(12.94±4.51)、(14.06±4.18)、(215.66±98.50)mmHg、(1.78±0.49)mmol/L、(36.84±3.56)g/L、(70.25±5.16)g/L明显高于B组(9.36±2.18)cmH2O、(10.85±3.54)、(12.25±3.64)、(182.55±72.68)mmHg、(0.69±0.08)mmol/L、(33.98±2.00)g/L、(65.01±8.25)g/L,差异有统计学意义(t=3.106 4、3.739 3、2.329 1、2.034 3、13.234 6、8.278 8、5.699 2,P<0.05);而血糖、Hct以及全身性炎症反应综合征评分等(8.65±2.13)mmol/L、(38.0±6.53)L/L、(16.86±5.02)分明显低于B组(14.56±3.85)mmol/L、(42.66±4.89)L/L、(20.65±4.12)分,差异有统计学意义(t=11.271 3、3.69 5、5.229 1,P<0.05);Logistic分析显示,导致患者预后不良的危险因素有高血糖和严重全身性炎症反应等,CBP治疗及PAHR则为有利因素;使用万汶治疗的患者其日均使用量与该类患者的血压、MAP及尿量呈正相关。结论高血糖和严重全身性炎症反应是重症感染毛细血管渗漏综合征相关危险因素,使用万汶治疗效果显著。

Objective To investigate the risk factors associated with severe leakage syndrome(CLS). Methods Group the medical records of 6690 critically ill patients admitted to our hospital from January 2005 to January 2017 were selected. Among them, 482 patients had CLS. According to the treatment of the disease, the patients were divided into three groups: A,B and C. Group A was cured patients(324 cases), group B was death(97 cases), group C was untreated patients(61 cases).CLS risk factors were analyzed in three groups. Results The CVP, PAHR, AG, oxygenation index, triglyceride, albumin and serum total protein in group A at admission were [(11.03±2.25) cmH2O,(12.94±4.51),(14.06±4.18),(215.66±98.50) mmHg,(1.78±0.49) mmol/L,(36.84±3.56) g/L,(70.25±5.16) g/L, which were significantly higher than those in group B(9.36±2.18 cmH2O,(10.85±3.54),(12.25±3.64),(182.55±72.68)mmHg,(0.69±0.08)mmol/L,(33.98±2.00)g/L,(65.01±8.25)g/L]. The difference between the two groups was statistically significant(t=3.106 4, 3.739 3, 2.329 1, 2.034 3, 13.234 6, 8.278 8,5.699 2, P<0.05). Blood glucose, Hct, and systemic inflammatory response syndrome scores of group B [(8.65±2.13)mmol/L,(38.0 ±6.53)L/L,(16.86 ±5.02)points] were significantly lower than those of group B [(14.56 ±3.85)mmol/L,(42.66 ±4.89)L/L,(20.65 ±4.12)points], and the difference was statistically significant(t=11.2713, 3.695, 5.2291, P <0.05). Logistic analysis showed that the risk factors for poor prognosis were hyperglycemia and severe systemic inflammatory response, and CBP treatment and PAHR were favorable factors. The average daily usage of voluven treatment was positively correlated with patients blood pressure, MAP and urine output. Conclusion Hyperglycemia and severe systemic inflammatory response are risk factors associated with severely infected capillary leak syndrome, and the effect of the treatment with voluven is significant.