影响急诊科脓毒症患者预后的危险因素及其对策分析

Risk factors influencing prognosis of patients with sepsis in emergency department and countermeasures

目的探讨急诊科脓毒症患者的预后转归及其相关危险因素,并提出对策和措施。方法选取2017年1月至2020年8月浙江省台州医院急诊科收治的277例脓毒症患者进行回顾性分析,依据预后情况将其分为存活组203例和死亡组74例;分析急诊科脓毒症患者的病死率,采用单因素比较法和多因素逐步logistic回归法分别筛选影响脓毒症患者预后死亡的危险因素,筛选的因素主要包括性别、年龄、高血压、糖尿病、心脑血管疾病、APACHEⅡ评分、SOFA评分、器官衰竭数、机械通气、CRRT治疗、中心静脉置管、使用血管活性药物、应用激素、C-反应蛋白、PCT、血肌酐等。结果急诊科277例脓毒症患者的病死率为26.71%(74/277);多因素结果显示,年龄(OR=2.983)、APACHEⅡ评分(OR=2.392)、器官衰竭数(OR=4.683)、CRRT治疗(OR=3.557)、C-反应蛋白(OR=3.732)、PCT(OR=2.601)等均为急诊科脓毒症患者预后死亡的高危因素。结论急诊科脓毒症患者具有较高的预后病死率,而且影响其预后死亡的危险因素较多,根据预后特点及其高危因素,应早发现、早诊断、早治疗脓毒症,降低死亡率,改善预后。

Objective To explore the prognosis and related risk factors in patients with sepsis in the emergency department,and to propose countermeasures.Methods A total of 277 patients with sepsis admitted to the emergency department of our hospital from January 2017 to August 2020 were selected for retrospective investigation.They were divided into the survival group(n=203)and the death group(n=74)according to the prognosis.The mortality rate of patients with sepsis in the emergency department was analyzed.Single-factor comparison and multi-factor stepwise logistic regression were used to screen the risk factors influencing the prognosis of death in patients with sepsis.The screened factors mainly included gender,age,hypertension,diabetes,cardiocerebrovascular disease,APACHE II score,SOFA score,number of organ failure,septic shock,mechanical ventilation,CRRT treatment,central venous catheterization,use of vasoactive medications,application of hormones,C-reactive protein,PCT,blood creatinine and other factors.Results The mortality rate of 277 sepsis patients in the emergency department was 26.71%(74/277).The multi-factor analysis showed that age(OR=2.983),APACHE II score(OR=2.392),number of organ failure(OR=4.683),CRRT treatment(OR=3.557),C-reactive protein(OR=3.732),and PCT(OR=2.601)were all high-risk factors for the prognosis of death in patients with sepsis in the emergency department.Conclusion Patients with sepsis in the emergency department have a high prognostic mortality rate,and there are many risk factors influencing the prognosis of death.Considering the prognostic characteristics and high-risk factors,early detection,early diagnosis,and early treatment of sepsis should be implemented to reduce mortality and improve the prognosis.