重症肺炎患者发生重度脓毒症的影响因素分析
摘要
目的分析重症肺炎患者发生重度脓毒症的影响因素。方法选取2014年1月20日至2017年10月20日于菏泽市中医医院重症监护病房住院的110例重症肺炎患者为研究对象,其中40例合并重度脓毒症。分析性别、年龄、饮酒史、合并症(糖尿病、冠心病、肝功能异常)、胸腔积液、病原微生物感染、抗生素治疗史、入院时肺炎严重指数(PSI)是否为重症肺炎患者发生重度脓毒症的影响因素。结果单因素分析结果显示,重症肺炎患者出现重度脓毒症与患者的年龄、抗生素治疗史、糖尿病史、冠心病史、胸腔积液、入院时PSI评分及病原学检查结果有关(均P<0.05)。多因素分析结果显示,年龄≥50岁、合并冠心病或糖尿病、PSI>Ⅲ级、革兰阴性菌感染、革兰阳性菌感染、混合感染是重症肺炎患者发生重度脓毒症的独立危险因素,使用抗生素治疗是其保护因素(均P<0.05)。结论年龄≥50岁、合并冠心病或糖尿病、入院时PSI>Ⅲ级、革兰阴性菌感染、革兰阳性菌感染、病原体混合感染、未接受抗生素治疗的重症肺炎患者较易发生重度脓毒症,应引起临床重视。
引文
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[6] MENéNDEZ R, TORRES A, REYES S, et al. Initial management of pneumonia and sepsis: factors associated with improved outcome[J]. Eur Respir J, 2012, 39(1): 156-162.
[7] RESTREPO M I, MORTENSEN E M, VELEZ J A, et al. A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU[J]. Chest, 2008, 133(3): 610-617.
[8] SCHAAF B M, BOEHMKE F, ESNAASHARI H, et al. Pneumococcal septic shock is associated with the interleukin-10-1082 gene promoter polymorphism[J]. Am J Respir Crit Care Med, 2003, 168(4): 476-480.
[9] KOSTIUKOVA N N, BEKHALO V A. Pneumococcus pathogenicity factors and their protective properties[J]. Zh Mikrobiol Epidemiol Immunobiol, 2014(3): 67-77.
[10] MONTULL B, MENéNDEZ R, TORRES A, et al. Predictors of severe sepsis among patients hospitalized for community-acquired pneumonia[J].MLO Med Lab Obs, 2016, 48(3): 10-12.
[2] WIENS J, SNYDER G M, FINLAYSON S, et al. Potential adverse effects of broad-spectrum antimicrobial exposure in the intensive care unit[J]. Open Forum Infect Dis, 2017, 5(2): ofx270.
[3] BLANCO J, MURIEL-BOMBíN A, SAGREDO V, et al. Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study[J]. Crit Care, 2008, 12(6): R158.
[4] SALDíAS P F, REYES B T, SáEZ B J, et al. Clinical predictors of bacteremia in immunocompetent adult patients hospitalized for community-acquired pneumonia[J]. Rev Med Chil, 2015, 143(5): 553-561.
[5] 贺立山, 翁孝刚. 内科学[M]. 7版. 西安: 第四军医大学出版社, 2008: 41.
[6] MENéNDEZ R, TORRES A, REYES S, et al. Initial management of pneumonia and sepsis: factors associated with improved outcome[J]. Eur Respir J, 2012, 39(1): 156-162.
[7] RESTREPO M I, MORTENSEN E M, VELEZ J A, et al. A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU[J]. Chest, 2008, 133(3): 610-617.
[8] SCHAAF B M, BOEHMKE F, ESNAASHARI H, et al. Pneumococcal septic shock is associated with the interleukin-10-1082 gene promoter polymorphism[J]. Am J Respir Crit Care Med, 2003, 168(4): 476-480.
[9] KOSTIUKOVA N N, BEKHALO V A. Pneumococcus pathogenicity factors and their protective properties[J]. Zh Mikrobiol Epidemiol Immunobiol, 2014(3): 67-77.
[10] MONTULL B, MENéNDEZ R, TORRES A, et al. Predictors of severe sepsis among patients hospitalized for community-acquired pneumonia[J].MLO Med Lab Obs, 2016, 48(3): 10-12.