1991～2001年ICU严重感染的流行病学调查分析

Severe sepsis in ICU during 1991 to 2001: a clinical epidemiological analysis

目的 调查严重感染的病死率和病死危险因素。方法 回顾性调查1991～2001年的383例严重感染患者,计算逐年病死率,进行单因素和多因素逐步logistic回归分析,分析严重感染患者病死危险因素。结果1991～2001年间,严重感染总病死率46％(176/383),11年间逐年病死率无显著变化(P=0.458)。13个因素参与多因素分析,结果显示严重感染病死危险因素有合并器官功能衰竭数目、免疫功能受累、低白蛋白(<35g/L)和接受有创性检查和治疗。严重感染患者合并器官功能衰竭的数目增多,病死率明显增加,合并2个器官衰竭者病死的相对危险度为3.748,3个器官衰竭者为9.663,而合并≥4个器官功能衰竭者病死的相对危险度高达28.810。从器官功能衰竭的分布来看,严重感染患者最常合并循环衰竭(62.9％)和呼吸衰竭(56.9％),而顽固的感染性休克是严重感染患者最主要的直接病死原因(39.8％)。结论 20世纪90年代以来,严重感染的病死率依然很高,探寻严重感染发病的危险因素,积极调控炎症反应,在炎症反应早期及时阻断炎症反应过程,防止发展为感染性休克和多器官功能障碍综合征,是降低严重感染病死率的关键。

Objective To study the mortality and related risk factors of severe sepsis in critically ill patients. Methods Three hundred and eighly-three critically ill patients with severe sepsis during 1991-2001 were studied retrospectively. Stepwise logistic regression analysis was performed to identify risk factors associatied with severe sepsis. Results The overall mortality of severe sepsis was 46% (176/383). The fatality showed no significant changes in this 11 years (P = 0.458). Stepwise logistic regression analysis identified the following risk factors: the number of failure organs, immunocompromise, low plasma albumin level and invasive treatmeat. The fatality rate of severe sepsis increased with the increase in the number of failure organs, The odds ratio (OR) of patients with two failure organs was 3.748, three organs was 9.663 and four organs was 28. 810. In patients with severe sepsis, circulatory failure (62. 9%) and respiratory failure (56.9%)were the most common complications. The major cause of death in patients with severe sepsis was refractory septic shock (39.8%). Conclusions The fatality rate of severe sepsis has remained unchanged since 1991. To control multiple organ dysfunction syndrome may be the most important therapeutic approach in the management of severe sepsis.