摘要
背景肺部感染合并脓毒症患者在临床上较为棘手,而准确评估患者病情和预后、及时调整治疗策略对改善患者预后具有重要意义。目的探究肺炎合并内科脓毒症患者预后的影响因素,旨在寻找能预警肺炎合并内科脓毒症患者预后的临床指标。方法本研究为回顾性研究,选取2013—2018年广东省中医院收治的肺炎合并内科脓毒症患者2855例,脓毒症符合Sepsis 2.0诊断标准。收集患者的临床资料及预后指标。肺炎合并内科脓毒症患者住院期间预后的影响因素分析采用多元Cox回归分析,肺炎合并内科脓毒症患者住院7、28、90 d内预后的影响因素分析采用多因素Logistic回归分析。结果多元Cox回归分析结果显示,年龄、序贯器官衰竭估计(SOFA)评分、查尔森合并症指数(CCI)评分、行心肺复苏术、输红细胞、输血浆、使用肾上腺素、降钙素原(PCT)及血乳酸(Lac)是肺炎合并内科脓毒症患者住院期间预后的独立影响因素(P<0.05)。多因素Logistic回归分析结果显示,SOFA评分、行心肺复苏术、输红细胞、输血浆、使用肾上腺素及Lac是肺炎合并内科脓毒症患者住院7 d内预后的独立影响因素(P<0.05);年龄、SOFA评分、行无创通气、行有创通气、行心肺复苏术、输血浆、使用去甲肾上腺素、使用肾上腺素及Lac是肺炎合并内科脓毒症患者住院28 d内预后的独立影响因素(P<0.05);年龄、行无创通气、行有创通气、行心肺复苏术、输红细胞、输血浆、使用肾上腺素及Lac是肺炎合并内科脓毒症患者住院90 d内预后的独立影响因素(P<0.05)。结论行心肺复苏术、输血浆、使用肾上腺素及Lac升高是肺炎合并内科脓毒症患者预后的危险因素,而年龄、SOFA评分、CCI评分、行无创通气、行有创通气、输红细胞、使用去甲肾上腺素及PCT是患者特定时间段预后的影响因素。
Background Pneumonia patients with sepsis are clinically tricky,so accurate assessment of patients'condition and prognosis,timely adjustment of treatment strategies are of great significance to improve the prognosis of patients.Objective To explore the prognostic factors of pneumonia patients with sepsis,in order to find the clinical indexes that can predict the prognosis of pneumonia patients with sepsis.Methods In this study,2855 pneumonia patients with sepsis between 2013 and 2018 were retrospectively collected and reviewed in Guangdong Provincial Hospital of Traditional Chinese Medicine.Sepsis met the Sepsis 2.0 diagnostic criteria.Clinical data and prognostic factors of patients were collected.The factors affecting the prognosis of pneumonia patients with sepsis during hospitalization were analyzed by multivariate Cox regression analysis,and the factors affecting the prognosis of pneumonia patients with sepsis at 7,28,and 90 days of hospitalization were analyzed by multivariate Logistic regression analysis.Results Multivariate Cox regression analysis showed that age,sequential organfailure eatimation(SOFA)score,Charlson Comorbidity Index(CCI)score,cardiopulmonary resuscitation,red blood cells transfusion,plasma transfusion,using of phenylephrine,procalcitonin(PCT)and blood lactate(Lac)were independent prognostic factors of pneumonia patients with sepsis during hospitalization(P<0.05).Multivariate Logistic regression analysis showed that SOFA score,cardiopulmonary resuscitation,red blood cells transfusion,plasma transfusion,using of phenylephrine,and Lac were independent prognostic factors within 7 days after hospitalization in pneumonia patients with sepsis(P<0.05);age,SOFA score,non-invasive ventilation,invasive ventilation,cardiopulmonary resuscitation,plasma transfusion,using of norepinephrine,using of phenylephrine and Lac were the independent prognostic factors within 28 days after hospitalization in pneumonia patients with sepsis(P<0.05);age,non-invasive ventilation,invasive ventilation,cardiopulmonary
作者
周仙仕
黄天华
李俊
李强
唐光华
ZHOU Xianshi;HUANGTianhua;LI Jun;LI Qiang;TANG Guanghua(Department of Emergency,Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120,China;Guangdong Provincial Key Laboratory of Research on Emergency in TCM,Guangzhou 510120,China;Department of Neurology,Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510405,China)
出处
《实用心脑肺血管病杂志》
2020年第12期57-63,70,共8页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
广东省中医院1010专项(YN10101908)
广东省中医急症研究重点实验室项目(2017B030314176)。
