某三甲医院ICU患者发生败血症的危险因素分析

Analysis of Risk Factors for Sepsis in ICU Patients of a Tertiary Hospital

目的分析某三甲医院重症监护病房(intensive care uni,ICU)患者发生败血症的危险因素。方法回顾性选取2021年1月—2023年12月在广西壮族自治区南溪山医院ICU住院的186例患者的临床资料,收集并比较败血症和非败血症患者的一般资料,并使用多因素二元Logistic回归分析ICU患者发生败血症的危险因素。结果186例ICU住院患者中有22例患者感染败血症,164例患者未感染败血症,败血症发生率为11.83%(22/186)。败血症患者和非败血症患者的年龄、糖尿病、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)、侵入性操作、预防性应用抗生素、意识障碍、中心静脉导管相关性血流感染、急性生理学与慢性健康状况评分系统Ⅱ(Acute Physiology and Chronic Health Evalution Scoring System,APACHEⅡ)和血白蛋白浓度情况比较,差异有统计学意义(P均<0.05)。多因素二元Logistic回归分析结果显示,存在糖尿病(OR=2.045,95%CI:1.067~4.226)、存在COPD(OR=1.034,95%CI:1.005~1.132)、有侵入性操作(OR=3.657,95%CI:2.344~6.827)、有预防性应用抗生素(OR=4.882,95%CI:3.274~7.954)、存在意识障碍(OR=2.167,95%CI:1.602~3.167)、存在中心静脉导管相关性血流感染(OR=1.065,95%CI:1.003~2.147)、APACHEⅡ评分(OR=3.471,95%CI:2.141~7.443)和血白蛋白浓度(OR=1.473,95%CI:1.117~1.826)是ICU患者发生败血症的独立危险因素(P均<0.05)。结论影响ICU患者发生败血症的主要因素有存在糖尿病、存在COPD、有侵入性操作、有预防性应用抗生素、存在意识障碍、中心静脉导管相关性血流感染、高APACHEⅡ评分和低血白蛋白浓度,针对以上因素给予患者的针对性预防,可降低败血症的发生率。

Objective To analyze the risk factors of sepsis in patients in intensive care unit(ICU)of a tertiary hospital.Methods The clinical data of 186 patients hospitalized in ICU of Nanxishan Hospital of Guangxi Zhuang Autonomous Region from January 2021 to December 2023 were retrospectively selected.The general data of patients with sepsis and non-sepsis were collected and compared,and multivariate binary Logistic regression was used to analyze the risk factors of sepsis in ICU patients.Results Among the 186 ICU inpatients,22 patients were infected with sepsis,and 164 patients were not infected with sepsis,the incidence of sepsis was 11.83%(22/186).Age,diabetes,chronic obstructive pulmonary disease(COPD),invasive procedures,prophylactic use of antibiotics,disturbance of consciousness,central venous catheter-related bloodstream infection,Acute Physiology and Chronic Health Evalution Scoring SystemⅡ(APACHEⅡ)score and serum albumin concentration were compared between sepsis patients and non-sepsis patients,and the differences were statistically significant(all P<0.05).Multivariate binary Logistic regression analysis showed that there was diabetes(OR=2.045,95%CI:1.067-4.226),COPD(OR=1.034,95%CI:1.005-1.132),invasive operation(OR=3.657,95%CI:2.344-6.827),prophylactic use of antibiotics(OR=4.882,95%CI:3.274-7.954),disturbance of consciousness(OR=2.167,95%CI:1.602-3.167),central venous catheter-related bloodstream infection(OR=1.065,95%CI:1.003-2.147),APACHEⅡscore(OR=3.471,95%CI:2.141-7.443)and serum albumin concentration(OR=1.473,95%CI:1.117-1.826)were independent risk factors for sepsis in ICU patients(all P<0.05).Conclusion The main factors affecting the occurrence of sepsis in ICU patients are diabetes,COPD,invasive operation,preventive application of antibiotics,disturbance of consciousness,central venous catheter-related bloodstream infection,high APACHEⅡscore and serum albumin concentration.Targeted prevention of patients against the above factors can reduce the incidence of sepsis.