脓毒症患者死亡危险因素研究进展

Research advances in risk factors of death in sepsis patients

脓毒症是一种严重危及生命的多器官功能障碍性疾病,具有较高的发病率和病死率,如何攻克脓毒症是世界性的难题。目前已证实脓毒症患者的死亡涉及到免疫功能紊乱、凝血功能紊乱、微循环障碍、代谢紊乱、多器官功能衰竭(MOF)等多种机制,在以上因素的共同作用下,脓毒症患者的病死率居高不下。因此早期识别出可能发生死亡的脓毒症患者并积极采取一系列预防性措施意义重大。脓毒症患者的死亡与多种因素密切相关,如高龄、男性、种族、基因差异等人口统计学特征,患者入院评分和并发症状况,各种实验室检测指标如中性粒细胞/淋巴细胞比值(NLR)、血小板计数(PLT)、降钙素原(PCT)、C-反应蛋白(CRP)、乳酸、D-二聚体、皮质醇等,还有不恰当的干预性治疗措施等。但以上各种死亡危险因素单独用于诊断脓毒症均有一定的局限性,综合考虑多种指标并结合患者的临床资料才能更准确地预测脓毒症患者的预后,进而对高危人群采取早期针对性治疗,降低脓毒症患者的病死率。

Sepsis is a serious life-threatening disease with multiple organ dysfunction,which has high morbidity and fatality rate.How to overcome sepsis is a worldwide problem.It has been confirmed that the death of sepsis patients involves multiple mechanisms such as immune disorder,coagulation disorder,microcirculation dysfunction,metabolic disorder and multiple organ failure(MOF).Under the combined action of above mechanisms,the fatality rate of sepsis patients is still high,so it is of great significance to identify possible dead sepsis patients and take a series of preventive measures.Studies have shown that many risk factors are closely associated with the death of sepsis patients,such as older age,male,ethnicity,gene differences and some other demographic characteristics,the score and complication status of patients at admission,some kinds of laboratory test indexes such as neutrophil-to-lymphocyte ratio(NLR),platelets count(PLT),procalcitonin(PCT),C-reactive protein(CRP),lactic acid,D-dimer,cortisol and some inappropriate interventions.However,the above risk factors have certain limitations when used alone in diagnosis.Only by comprehensively considering a variety of indicators and combining with the clinical data of patients,can the prognosis of sepsis patients be predicted more accurately,and then early targeted treatment can be adopted for high-risk groups to reduce the mortality of sepsis patients.