脓毒症预后的临床特点及其相关危险因素调查分析
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摘要
目的:探讨脓毒症预后的临床特点及其相关危险因素,为临床改善脓毒症预后提供依据。方法:回顾性收集115例脓毒症患者的临床资料,依据预后情况分为死亡组(n=40)和存活组(n=75),采用病例对照研究的方法,应用单因素和多因素法来分析影响脓毒症预后死亡的相关危险因素。结果:脓毒症预后死亡率为34.8%(40/115);多因素分析结果显示年龄(OR=7.071)、并发急性肾损伤(OR=4.175)、器官衰竭数目(OR=2.440)、尿素氮(OR=3.080)、C反应蛋白(OR=1.859)、APACHEⅡ评分(OR=5.256)等因素均为脓毒症预后的危险因素。结论:脓毒症预后死亡率较高,其高危因素包括高龄、并发急性肾损伤、多器官功能衰竭、尿素氮和C反应蛋白升高、APACHEⅡ评分高等,应针对这些高危因素采取必要的干预措施。
Objective:To explore clinical features and correlated risk factors of prognosis of sepsis patients,then provide basis for improving prognosis of sepsis.Methods:Retrospectively collecting 115 cases data of sepsis patients,these cases were divided into death group(n=40) and survival group(n=75) according to the prognosis.With Case-Control study method,the correlated risk factors of prognosis death of sepsis were analyzed by single and multiple factors analysis methods.Results:The death rate of sepsis prognosis was34.8%(40/115).Multiple factors analysis result showed that the factors of age(OR=7.071),complication of acute kidney injury(OR=4.175),the numbers of organ failure(OR=2.440),urea nitrogen(OR=3.080),C reactive protein(OR=1.859) and APACHEⅡscore(OR=5.256) were the risk factors of sepsis prognosis.Conclusion:The death rate of sepsis prognosis lies in a high rate.The high risk factors of sepsis prognosis include high age,complication of acute kidney injury,multiple organ failure,urea nitrogen and C reactive protein increased,high APACHEⅡ score.Intervention measures should be adopted to aim directly at these high risk factors.
Objective:To explore clinical features and correlated risk factors of prognosis of sepsis patients,then provide basis for improving prognosis of sepsis.Methods:Retrospectively collecting 115 cases data of sepsis patients,these cases were divided into death group(n=40) and survival group(n=75) according to the prognosis.With Case-Control study method,the correlated risk factors of prognosis death of sepsis were analyzed by single and multiple factors analysis methods.Results:The death rate of sepsis prognosis was34.8%(40/115).Multiple factors analysis result showed that the factors of age(OR=7.071),complication of acute kidney injury(OR=4.175),the numbers of organ failure(OR=2.440),urea nitrogen(OR=3.080),C reactive protein(OR=1.859) and APACHEⅡscore(OR=5.256) were the risk factors of sepsis prognosis.Conclusion:The death rate of sepsis prognosis lies in a high rate.The high risk factors of sepsis prognosis include high age,complication of acute kidney injury,multiple organ failure,urea nitrogen and C reactive protein increased,high APACHEⅡ score.Intervention measures should be adopted to aim directly at these high risk factors.
引文
[1]Dellinger RP,Levy MM,Rhodes A,et al.Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2012[J].Crit Care Med,2013,41(2):580-637.
[2]李立斌,严静.脓毒症的生物标记物:过去、现在和未来[J].中华急诊医学杂志,2013,22(9):954-956.
[3]蒋鹏,苏斌虓,柴薪,等.影响脓毒症患者预后的危险因素分析[J].现代仪器与医疗,2016,22(2):83-84.
[4]李欣,李景辉.脓毒症动物模型制备的影响因素及研究进展[J].中华危重症医学杂志(电子版),2015,8(1):53-57.
[5]Levy MM,Fink MP,Marshall JC,et al.2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference[J].Crit Care Med,2003,31(4):1250-1256.
[6]李鹏声,梁融,周舒冬,等.应用logistic回归模型间接估计RR/PR的方法探讨[J].中国卫生统计,2014,31(6):949-951.
[7]Jose L,Paulo F,Sofia J,et al.Long-term risk of mortality after acute kidney injury in patients with sepsis:a contemporary analysis[J].BMC Nephrol,2010,11(2):9.
[8]范泉,张泓.脓毒症患者预后危险因素的Logistic回归分析[J].安徽医科大学学报,2014,49(10):1479-1481.
[9]冯珍珍.影响脓毒症预后的相关因素分析[D].广西医科大学,2016,1-34.
[10]黄波,姚明.成人烧伤脓毒症患者的转归及其危险因素分析[J].宁夏医学杂志,2017,39(4):352-354.
[11]王娇,刘雪燕,方红辉.影响血培养阳性脓毒症临床预后及转归的相关因素[J].中国实用医刊,2015,42(13):96-97.
[12]潘爱军,邓艳如,杨田军,等.脓毒症外周血自然杀伤细胞表型和功能及其临床意义[J].中华危重病急救医学,2014,26(11):827-831.
[13]陈妙莲,李建伟,梁宏开.脓毒症合并急性肾损伤的相关危险因素及预后分析[J].现代诊断与治疗,2017,28(1):180-182.
[14]陈强.严重脓毒症患者死亡相关危险因素分析[J].临床医学研究与实践,2016,1(5):12-13.
[15]韩静,邱俏檬,吴斌,等.脓毒症并发急性肾损伤患者临床特及预后因素分析[J].中华危重医学杂志(电子版),2014,7(1):30-33.
[16]刘娟,苏震,张周沧.脓毒症合并急性肾损伤患者发病及预后的多因素分析[J].中华医学杂志,2011,91(16):1112-1114.
[17]曹书华.脓毒症与多脏器功能失常综合征[J].中华急诊医学杂志,2010,19(7):781-782.
[18]龙儒瑾,金魁,刘宝.严重脓毒症发生急性肾损伤危险因素及预后分析[J].包头医学,2016,40(4):193-196.
[19]喻文,罗红敏.脓毒症患者在ICU中继发二次感染的发生率、危险因素及归因病死率[J].中华危重病急救医学,2016,28(8):746-746.
[20]Chan T,Gu F.Early diagnosis of sepsis using serum biomarkers[J].Expert Rev Mol Diagn,2011,11(5):487-496.
[21]Berger B,Gumbinger C,Steiner T,et al.Epidemiologic features,risk factors,and outcome of sepsis in stroke patients treated on neurologic intensive care unit[J].J Crit Care,2014,29(2):241-248.
[2]李立斌,严静.脓毒症的生物标记物:过去、现在和未来[J].中华急诊医学杂志,2013,22(9):954-956.
[3]蒋鹏,苏斌虓,柴薪,等.影响脓毒症患者预后的危险因素分析[J].现代仪器与医疗,2016,22(2):83-84.
[4]李欣,李景辉.脓毒症动物模型制备的影响因素及研究进展[J].中华危重症医学杂志(电子版),2015,8(1):53-57.
[5]Levy MM,Fink MP,Marshall JC,et al.2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference[J].Crit Care Med,2003,31(4):1250-1256.
[6]李鹏声,梁融,周舒冬,等.应用logistic回归模型间接估计RR/PR的方法探讨[J].中国卫生统计,2014,31(6):949-951.
[7]Jose L,Paulo F,Sofia J,et al.Long-term risk of mortality after acute kidney injury in patients with sepsis:a contemporary analysis[J].BMC Nephrol,2010,11(2):9.
[8]范泉,张泓.脓毒症患者预后危险因素的Logistic回归分析[J].安徽医科大学学报,2014,49(10):1479-1481.
[9]冯珍珍.影响脓毒症预后的相关因素分析[D].广西医科大学,2016,1-34.
[10]黄波,姚明.成人烧伤脓毒症患者的转归及其危险因素分析[J].宁夏医学杂志,2017,39(4):352-354.
[11]王娇,刘雪燕,方红辉.影响血培养阳性脓毒症临床预后及转归的相关因素[J].中国实用医刊,2015,42(13):96-97.
[12]潘爱军,邓艳如,杨田军,等.脓毒症外周血自然杀伤细胞表型和功能及其临床意义[J].中华危重病急救医学,2014,26(11):827-831.
[13]陈妙莲,李建伟,梁宏开.脓毒症合并急性肾损伤的相关危险因素及预后分析[J].现代诊断与治疗,2017,28(1):180-182.
[14]陈强.严重脓毒症患者死亡相关危险因素分析[J].临床医学研究与实践,2016,1(5):12-13.
[15]韩静,邱俏檬,吴斌,等.脓毒症并发急性肾损伤患者临床特及预后因素分析[J].中华危重医学杂志(电子版),2014,7(1):30-33.
[16]刘娟,苏震,张周沧.脓毒症合并急性肾损伤患者发病及预后的多因素分析[J].中华医学杂志,2011,91(16):1112-1114.
[17]曹书华.脓毒症与多脏器功能失常综合征[J].中华急诊医学杂志,2010,19(7):781-782.
[18]龙儒瑾,金魁,刘宝.严重脓毒症发生急性肾损伤危险因素及预后分析[J].包头医学,2016,40(4):193-196.
[19]喻文,罗红敏.脓毒症患者在ICU中继发二次感染的发生率、危险因素及归因病死率[J].中华危重病急救医学,2016,28(8):746-746.
[20]Chan T,Gu F.Early diagnosis of sepsis using serum biomarkers[J].Expert Rev Mol Diagn,2011,11(5):487-496.
[21]Berger B,Gumbinger C,Steiner T,et al.Epidemiologic features,risk factors,and outcome of sepsis in stroke patients treated on neurologic intensive care unit[J].J Crit Care,2014,29(2):241-248.