老年脓毒症人群发生脑病的病例对照研究

A Case-control Study of Encephalopathy in the Elderly with Sepsis.

目的探讨老年脓毒症相关性脑病(sepsis associated encephalopathy,SAE)的临床特点及其发生、发展的危险因素。方法纳入2018年7月~2020年1月入住浙江大学医学院附属杭州市第一人民医院重症医学科的老年脓毒症患者,按照是否出现SAE分为老年SAE组和老年非SAE组,对比两组患者一般资料、疾病类型、基础疾病、疾病严重程度、感染部位、致病微生物、入组后实验室检查(外周血白细胞计数、降钙素原浓度、血小板计数、血细胞比容、血钠浓度、血肌酐)的差别。采用二分类Logistic回归分析方法研究老年脓毒症患者发生SAE的危险因素。结果共纳入80例老年脓毒症患者,其中59例发生SAE(73.75%)。单因素分析提示基础合并冠心病、呼吸道感染、血流感染、疾病严重程度、降钙素原浓度与老年脓毒症患者发生SAE存在相关性(P<0.05)。Logistic回归分析结果发现较高的急性生理与慢性健康状况评分(acute physiology and chronic health evaluation,APACHEⅡ)(OR=1.266,95%CI:1.080~1.485,P=0.004)是老年脓毒症患者发生SAE的独立危险因素。结论SAE具有较高的发生率,较高的APACHEⅡ是老年脓毒症患者发生SAE的独立危险因素。

Objective To clarify the clinical characteristics of elderly SAE and the risk factors for its occurrence and development.Methods Our retrospective study included elderly sepsis patients admitted to the Department of Critical Care Medicine,Hangzhou First People′s Hospital,Zhejiang University School of Medicine from July 2018 to January 2020.According to whether SAE occurs,it is divided into elderly SAE group and elderly non-SAE group.The data differences between the two groups were compared,including general information,disease type,underlying disease,disease severity,infection site,pathogenic microorganisms,and laboratory indicators after joining the group(peripheral blood white blood cell count,procalcitonin concentration,platelet count,hematocrit,blood sodium concentration,blood creatinine)(P<0.05).The binary Logistic regression analysis method was used to study the risk factors of SAE in elderly patients with sepsis.Results A total of 80 patients with sepsis in the elderly were enrolled,of which 59 had SAE(73.75%).Univariate analysis suggests that the following factors may be associated with SAE in elderly patients with sepsis,including underlying coronary heart disease,respiratory tract infection,bloodstream infection,disease severity,and procalcitonin concentration.Logistic regression analysis showed that the higher APACHEⅡscore(OR=1.266,95%CI:1.080-1.485,P=0.004)was an independent risk factor for SAE in elderly patients with sepsis.Conclusion SAE has a higher incidence.A higher APACHEⅡscore is an independent risk factor for SAE in elderly patients with sepsis.