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目的研究老年念珠菌血症所致感染性休克患者的相关因素,探讨判断疗效和预后的指标。方法回顾性分析广东省老年医学研究所ICU 31例经血培养确诊念珠菌血症所致感染性休克患者(非中性粒细胞减少或缺乏)的临床资料,根据28天预后分为生存组和死亡组,观察两组患者第1、2、3、5和7天血降钙素原、C-反应蛋白、白细胞计数、血乳酸、序贯器官衰竭估计评分(SOFA)和急性生理与慢性健康状况系统Ⅱ评分(APACHEⅡ评分)等指标的动态变化,并对两组患者的相关资料进行统计学分析。结果死亡组16例,生存组15例;血培养结果以非白色念珠菌居多(71%)、白色念珠菌占29%;两组患者第1天APACHEⅡ评分和第1天血降钙素原差异有统计学意义。死亡组APACHEⅡ评分高于生存组[(27.63±5.14)vs.(22.60±5.88),P=0.017];生存组第1天血降钙素原[(2.74±2.32)ng/m L]较死亡组[(1.45±1.01)ng/mL]高(P=0.045);两组血降钙素原水平均随时间而变化(P<0.05)且两组变化趋势的差异有统计学意义(P<0.05),变化曲线显示生存组第3天血降钙素原到达高峰[(4.27±5.19)ng/mL]、其后逐渐下降,而死亡组呈逐渐上升趋势(P=0.004)。Logistic回归分析显示,第1天血降钙素原和APACHEⅡ评分是影响28天预后的独立危险因素,分别为比值比=0.272(95%可信区间0.084~0.883,P=0.030)和比值比=1.349(95%可信区间1.052~1.731,P=0.018)。两组白细胞计数、C-反应蛋白、血乳酸和SOFA评分在各时间点的变化趋势差异无统计学意义。结论老年念珠菌血症所致感染性休克患者(非中性粒细胞减少或缺乏),应早期选用覆盖非白色念珠菌的药物;血降钙素原水平和APACHEⅡ评分值是影响28天预后的独立危险因素;对相关指标的动态观察评估临床意义更大。
Objective To study the related factors of septic shock caused by Candida albicans in elderly patients and to explore the indicators of efficacy and prognosis. Methods The clinical data of 31 patients with ICU admitted to Guangdong Institute of Geriatrics who were diagnosed as septic shock caused by candida sepsis by blood culture (non-neutropenia or lack of) were retrospectively analyzed. According to the prognosis of 28 days, they were divided into survival group and death Group, blood procalcitonin, C-reactive protein, white blood cell count, blood lactate, sequential organ failure assessment score (SOFA) and acute physiology and chronic health status were observed on the 1st, 2nd, 3rd, 5th and 7th days System Ⅱ score (APACHE Ⅱ score) and other indicators of the dynamic changes, and two groups of patients with relevant data for statistical analysis. Results 16 cases died and 15 cases survived. The results of blood culture were mostly non-Candida albicans (71%) and Candida albicans (29%). On the first day of APACHEⅡscore and blood procalcitonin There is statistical significance. APACHEⅡscore in the death group was higher than that in the survival group [(27.63 ± 5.14) vs. (22.60 ± 5.88), P = 0.017]; the level of plasma procalcitonin [(2.74 ± 2.32) ng / m L] (1.45 ± 1.01) ng / mL] (P = 0.045). The plasma procalcitonin levels in both groups changed with time (P <0.05), and there was significant difference between the two groups (P <0.05 ). The change curve showed that the peak level of procalcitonin in the survival group reached the peak at the third day [(4.27 ± 5.19) ng / mL], then gradually decreased, while the death group showed a gradual upward trend (P = 0.004). Logistic regression analysis showed that on the first day, the procalcitonin and APACHEⅡscores were independent risk factors affecting the 28-day prognosis, which were odds ratio = 0.272 (95% confidence interval 0.084-0.883, P = 0.030) and odds ratio = 1.349 (95% confidence interval 1.052-1.731, P = 0.018). There was no significant difference in the trend of change of white blood cell count, C-reactive protein, blood lactic acid and SOFA between the two groups at each time point. Conclusions Patients with septic shock caused by senile candidal bacteremia (non-neutropenia or lack of) should be selected early coverage of non-Candida albicans drugs; blood procalcitonin levels and APACHE Ⅱ score is the impact of 28-day prognosis Independent risk factors; dynamic observation of the relevant indicators of clinical significance of evaluation.