| 摘要: |
| 目的 探讨脓毒症患者住院期间临床有创干预措施及24 h内入院指标与入院28 d内死亡的相关性。方法 回顾性分析解放军总医院第一医学中心2016年1月至2018年12月收治的112例脓毒症患者的临床资料，分析住院期间4项临床有创干预措施［机械通气、气管插管、连续肾脏替代疗法（CRRT）、深静脉置管］及可能影响脓毒症患者死亡的入院指标（包括人口统计学特征、生命体征、实验室指标等），并以患者入院28 d的生存情况为结局变量，比较生存组（n=81）和死亡组（n=31）之间上述指标的差异，然后利用多因素logistic回归分析确定脓毒症患者入院28 d内死亡的独立危险因素。结果 两组患者在年龄、序贯器官衰竭评分、急性生理学和慢性健康状况Ⅱ（APACHEⅡ）评分、IL-6水平、降钙素原水平、天冬氨酸转氨酶水平、CRRT、深静脉置管方面的差异均有统计学意义（P均<0.05）。多因素logistic回归分析结果显示，IL-6水平升高（OR=1.001，P=0.011）、降钙素原水平降低（OR=0.966，P=0.005）、采用CRRT（OR=6.846，P=0.002）是脓毒症患者入院28 d内死亡的独立危险因素。结论 IL-6水平升高、降钙素原水平降低、住院期间使用CRRT的脓毒症患者入院28 d内死亡风险较高，密切观察并动态监测这些因素有助于早期识别可能发生不良结局的脓毒症患者；必不可少的机械通气、气管插管、CRRT、深静脉置管等临床有创干预的实施比例在死亡患者中较高，临床医师应认真评估、准确把握其中的平衡点。 |
| 关键词: 脓毒症 预后 危险因素 logistic模型 肾替代疗法 |
| DOI：10.16781/j.0258-879x.2020.05.0535 |
| 投稿时间：2019-08-19修订日期：2020-03-09 |
| 基金项目:军事医学创新工程专项（18CXZ025）. |
|
| Correlation between clinical invasive interventions and death within 28-day after admission in sepsis patients |
| ZHAO Peng-yue,LI Song-yan,YANG Xing-peng,ZHU Sheng-yu,GAO Zi-he,SONG Jian-lin,LIU Zhi-long,DU Xiao-hui* |
(Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the relationship between the clinical invasive interventions during hospitalization and the admission indicators within 24 hours with death within 28-day after admission in sepsis patients. Methods The clinical data of 112 sepsis patients who were admitted to the First Medical Center of Chinese PLA General Hospital from Jan. 2016 to Dec. 2018 were analyzed retrospectively. Four clinical invasive interventions (mechanical ventilation, tracheal intubation, continuous renal replacement therapy[CRRT] and deep vein catheterization) and admission indicators (including demographic characteristics, vital signs and laboratory indexes) that may have an impact on the death of sepsis patients were selected during hospitalization, and the 28-day survival of patients was taken as the outcome variable. The above parameters were compared between the survival group (n=81) and the death group (n=31), and the independent risk factors of sepsis death within 28-day after admission were determined by multivariate logistic regression analysis. Results There were statistically significant differences in age, the sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, IL-6, procalcitonin, aspartate aminotransferase, CRRT and deep vein catheterization between the two groups (all P<0.05). The results of the multivariate logistic regression analysis revealed that high IL-6 level (odds ratio[OR]=1.001, P=0.011), low procalcitonin level (OR=0.966, P=0.005) and CRRT (OR=6.846, P=0.002) were independent risk factors of death within 28-day after admission in sepsis patients. Conclusion Sepsis patients with increased IL-6 level, decreased procalcitonin level and CRRT during hospitalization have a higher risk of death within 28-day after admission. Close observation and dynamic monitoring of changes in IL-6, procalcitonin and renal function will be beneficial for early identification of septic patients who might have adverse clinical outcomes. The proportions of essential invasive interventions such as mechanical ventilation, tracheal intubation, CRRT, and deep venous catheterization are higher in dead patients, so clinicians need to carefully evaluate and accurately grasp the balance point. |
| Key words: sepsis prognosis risk factors logistic models renal replacement therapy |
