中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2014年
3期
171-174
,共4页
林瑾%刘培%庄海舟%段美丽%李昂
林瑾%劉培%莊海舟%段美麗%李昂
림근%류배%장해주%단미려%리앙
重度脓毒症%病死率%流行病学%危险因素
重度膿毒癥%病死率%流行病學%危險因素
중도농독증%병사솔%류행병학%위험인소
Severe sepsis%Mortality%Epidemiologic study%Risk factor
目的 探讨综合重症监护病房(ICU)重度脓毒症的流行病学特点及其死亡危险因素.方法 采用回顾性研究方法,选取2009年1月至2012年12月北京友谊医院ICU收治的419例重度脓毒症患者,对其临床资料进行收集与统计,分析临床特征,采用logistic回归分析明确重度脓毒症死亡的独立危险因素.结果 重度脓毒症的ICU病死率为43.9％(184/419);感染部位以呼吸道(50.8％)、胃肠道及腹腔(27.8％)、血流感染(4.3％)为主；革兰阴性菌为最常见致病菌[46.0％ (214/465)]；在纳入研究的重度脓毒症患者中院内获得性感染约占53.7％(225/419).Logistic回归分析显示:年龄[优势比(OR)=0.003,95％可信区间(95％CI)为1.015～1.056,P=0.000]、血管活性药物应用(OR=3.251,95％CI为1.562～6.768,P=0.002)、器官功能衰竭≥3个(OR=2.452,95％CI为1.015 ～ 5.924,P=0.046)、院内获得性感染(OR=1.775,95％ CI为0.981～3.221,P=0.046)为重度脓毒症患者死亡的独立危险因素.结论 重度脓毒症是ICU收治患者中的常见疾病,合并死亡危险因素的重度脓毒症患者应给予更为密切的监测和积极的治疗.
目的 探討綜閤重癥鑑護病房(ICU)重度膿毒癥的流行病學特點及其死亡危險因素.方法 採用迴顧性研究方法,選取2009年1月至2012年12月北京友誼醫院ICU收治的419例重度膿毒癥患者,對其臨床資料進行收集與統計,分析臨床特徵,採用logistic迴歸分析明確重度膿毒癥死亡的獨立危險因素.結果 重度膿毒癥的ICU病死率為43.9％(184/419);感染部位以呼吸道(50.8％)、胃腸道及腹腔(27.8％)、血流感染(4.3％)為主；革蘭陰性菌為最常見緻病菌[46.0％ (214/465)]；在納入研究的重度膿毒癥患者中院內穫得性感染約佔53.7％(225/419).Logistic迴歸分析顯示:年齡[優勢比(OR)=0.003,95％可信區間(95％CI)為1.015～1.056,P=0.000]、血管活性藥物應用(OR=3.251,95％CI為1.562～6.768,P=0.002)、器官功能衰竭≥3箇(OR=2.452,95％CI為1.015 ～ 5.924,P=0.046)、院內穫得性感染(OR=1.775,95％ CI為0.981～3.221,P=0.046)為重度膿毒癥患者死亡的獨立危險因素.結論 重度膿毒癥是ICU收治患者中的常見疾病,閤併死亡危險因素的重度膿毒癥患者應給予更為密切的鑑測和積極的治療.
목적 탐토종합중증감호병방(ICU)중도농독증적류행병학특점급기사망위험인소.방법 채용회고성연구방법,선취2009년1월지2012년12월북경우의의원ICU수치적419례중도농독증환자,대기림상자료진행수집여통계,분석림상특정,채용logistic회귀분석명학중도농독증사망적독립위험인소.결과 중도농독증적ICU병사솔위43.9％(184/419);감염부위이호흡도(50.8％)、위장도급복강(27.8％)、혈류감염(4.3％)위주；혁란음성균위최상견치병균[46.0％ (214/465)]；재납입연구적중도농독증환자중원내획득성감염약점53.7％(225/419).Logistic회귀분석현시:년령[우세비(OR)=0.003,95％가신구간(95％CI)위1.015～1.056,P=0.000]、혈관활성약물응용(OR=3.251,95％CI위1.562～6.768,P=0.002)、기관공능쇠갈≥3개(OR=2.452,95％CI위1.015 ～ 5.924,P=0.046)、원내획득성감염(OR=1.775,95％ CI위0.981～3.221,P=0.046)위중도농독증환자사망적독립위험인소.결론 중도농독증시ICU수치환자중적상견질병,합병사망위험인소적중도농독증환자응급여경위밀절적감측화적겁적치료.
Objective To investigate the epidemiological characteristics and mortality risk factors of severe sepsis patients admitted into intensive care unit (ICU).Methods The clinical data of 419 severe sepsis patients admitted to an adult ICU of Beijing Friendship Hospital from January 2009 to December 2012 were retrospectively analyzed and evaluated.Logistic regression analysis was employed to identify independent risk factors for the death of patients with severe sepsis during ICU stay.Results Overall ICU mortality was 43.9％ (184/419),and the respiratory tract was the most common site of infection (50.8％),followed by infection of the gastrointestinal tract and abdominal cavity (27.8％),and hematogenous infection (4.3％).Gram-negative bacteria were the most common pathogens [46.0％ (214/465)].Iatrogenic infections accounted for 53.7％ (225/419) of the enrolled patients.Logistic regression analysis showed that age [odds ratio (OR)=0.003,95％ confidence interval (95％CI) 1.015-1.056,P=0.O00],vasoactive drug application (OR=3.251,95％CI 1.562-6.768,P=0.002),failure of 3 or more organs (OR=2.452,95％ CI 1.015-5.924,P=0.046),and iatrogenic infection (OR =1.775,95％ CI 0.981-3.221,P=0.046) were independent risk factors for ICU mortality.Conclusions Severe sepsis is a common cause of ICU admission.Patients with risk factors for high mortality should be carefully monitored,and aggressive treatment should be administered.
