重症医学科脓毒症和脓毒性休克患者影响预后相关因素分析

Analysis of prognostic factors in patients with sepsis and septic shock in intensive care unit

目的探讨脓毒症和脓毒性休克患者死亡危险因素,分析重症医学科(ICU)影响患者预后的相关因素。方法选取2016年6月-2018年10月我院ICU脓毒症和脓毒性休克患者,按随访60d是否存活分为两组,生存组与死亡组,记录两组患者的一般临床资料、住院天数、急性生理与慢性健康评分(APACHEⅡ评分)、基础疾病以及实验室检查,来判断影响患者死亡的独立危险因素。结果共纳入168例符合入选标准的脓毒性休克患者,其中66例在出院后60d内死亡,102例存活,死亡率为39.3%。生存和死亡组在性别、年龄和住院时间上差异无统计学意义。两组患者相比,死亡组入院时的APACHEⅡ评分更高(P<0.05),差异具有统计学意义。基础疾病中,死亡组患有慢性阻塞性肺疾病(COPD)44例,生存组56例;死亡组有高血压疾病63例,生存组69例;死亡组慢性肝病34例,生存组30例;死亡组肿瘤21例,生存组18例,生存组与死亡组相比差异均有统计学意义(P<0.05)。而患者有冠状动脉粥样硬化性心脏病、慢性肾功能不全、糖尿病和脑中风,生存组与死亡组相比差异无统计学意义。将患者合并症进行分层分析,发现合并症个数两组间差异无统计学意义。实验室检查,生存组与死亡组患者刚收入ICU及治疗36h内,C反应蛋白、白细胞计数、氧合指数、血乳酸、血肌酐、血小板计数,两组间差异无统计学意义。入住ICU37~48h后死亡组C反应蛋白水平显著高于生存组,差异有统计学意义(P<0.05)。结论基础疾病中COPD、肿瘤、高血压、慢性肝脏疾病,以及治疗37~48h后高C反应蛋白水平、高APACHEⅡ评分是脓毒性休克患者死亡的独立高危因素。

Objective To investigate the risk factors of death in patients with sepsis and septic shock and analyze the prognostic factors of patients in ICU.Methods A total of 168 patients with sepsis and septic shock in ICU from June 2016 to October 2018 were enrolled.The patients were stratified in terms of survival time(60 days or not).General clinical data,length of hospital stay,APACHE II score,underlying diseases,and laboratory data were used to analyze the independent risk factors of patient mortality.Results Of the 168 patients enrolled,66(39.3%)died within 60 days of discharge and 102 survived.Survivor and non-survivor groups did not show significant difference in gender,age,and length of hospital stay.APACHE II score in the non-survivor group was significantly higher than survivor group(P<0.05).Considering the underlying diseases in the non-survivor group and survivor group,chronic obstructive pulmonary disease was found in 44 and 56 cases;hypertension in 63 and 69 cases;chronic liver disease in 34 and 30 cases;tumor in 21 and 18 cases,respectively(P<0.05).The prevalence of coronary atherosclerotic heart disease,chronic renal insufficiency,diabetes mellitus,and stroke did not show significant difference between the two groups.The patients in both survivor group and non-survivor group did not show significant difference in C-reactive protein,white blood cell count,oxygenation index,blood lactate,serum creatinine,and platelet count within 36 hours in ICU.After 37-48 hours of treatment,C-reactive protein level was significantly higher in survivor group than non-survivor group(P<0.05).Conclusion Underlying chronic obstructive pulmonary disease,tumor,hypertension,chronic liver disease,high C-reactive protein level after treatment for 37-48 hours,and high APACHE II score are independent risk factors for death of septic patients in ICU.