论文部分内容阅读
目的分析重症监护病房(intensive care unit,ICU)创伤后感染患者并发脓毒症的危险因素。方法收集2012-2015年重庆市某三级甲等教学医院综合ICU因创伤入院且发生感染的患者227例,其中男性174例,女性53例。根据患者是否并发脓毒症将其分为脓毒症组(n=168)和非脓毒症组(n=59),记录两组患者的一般资料、损伤情况、感染情况、病理生理特征等,采用SPSS 17.0统计软件分析可能导致脓毒症的相关因素。结果创伤后感染患者脓毒症发生率为74.01%。与非脓毒症组比较,脓毒症组患者入ICU后24 h内液入量、中心置管、有创机械通气、有创机械通气持续时间、输血、血液感染、外伤创面或外科手术部位感染等较多,入院时序贯性器官功能衰竭评分(sequential organ failure score,SOFA)、损伤严重度评分(injury severity score,ISS)、新损伤严重度评分(new injury severity score,NISS)等较高(P<0.05)。经Logistic单因素和多因素逐步回归分析筛选出7个危险因素:入院时SOFA较大(OR=2.64,95%CI:1.27~5.46,P=0.009)、入ICU时功能障碍系统的个数增加(OR=2.10,95%CI:1.35~3.27,P=0.001)、入ICU 24 h内血p H值异常(OR=3.16,95%CI:1.43~6.99,P=0.005)、入ICU 24 h内脉压差平均值增大(OR=1.52,95%CI:1.09~2.11,P=0.014)、存在葡萄球菌属感染(OR=4.32,95%CI:1.54~12.07,P=0.005)、存在外伤创面或外科手术部位感染(OR=3.73,95%CI:1.12~12.46,P=0.032)、有创机械通气持续时间增加(OR=1.94,95%CI:1.36~2.77,P<0.01)。结论严密监测创伤患者入ICU 24 h内p H值及脉压差变化,预防创面及外科手术部位感染,避免葡萄球菌属感染,减少有创机械通气持续时间等,有望降低其脓毒症发生率及致死率。
Objective To analyze the risk factors of sepsis in patients with traumatic infection after intensive care unit (ICU). Methods A total of 227 admitted patients with ICU admitted to a tertiary teaching hospital in Chongqing from 2012 to 2015 were retrospectively analyzed, including 174 males and 53 females. The patients were divided into sepsis group (n = 168) and non-sepsis group (n = 59) according to whether they were complicated by sepsis or not. The general information, injury status, infection status, pathophysiological characteristics and so on SPSS 17.0 statistical software was used to analyze the possible causes of sepsis. Results The incidence of sepsis in patients with post-traumatic infection was 74.01%. Compared with non-sepsis group, sepsis patients within 24 h after ICU into the liquid volume, central catheterization, invasive mechanical ventilation, invasive mechanical ventilation duration, blood transfusion, blood infection, trauma wound or surgical site Infection and so on. The scores of sequential organ failure score (SOFA), injury severity score (ISS), new injury severity score (NISS) P <0.05). Seven risk factors were screened by stepwise logistic regression and multivariate regression analysis. SOFA was higher on admission (OR = 2.64, 95% CI: 1.27-5.46, P = 0.009). The number of dysfunctions increased (OR = 2.10, 95% CI: 1.35-3.27, P = 0.001). The abnormal blood p H values within 24 hours after ICU admission (OR = 3.16, 95% CI: 1.43-6.99, P = 0.005) (OR = 1.52, 95% CI: 1.09-2.11, P = 0.014), presence of staphylococcus infection (OR = 4.32, 95% CI: 1.54-12.07, P = 0.005) (OR = 3.73, 95% CI: 1.12-12.46, P = 0.032). The duration of invasive mechanical ventilation increased (OR = 1.94, 95% CI: 1.36-2.77, P <0.01). Conclusion It is expected that the incidence of sepsis will be reduced by closely monitoring the change of p H value and pulse pressure within 24 h of trauma patients, preventing the infection of wounds and surgical sites, avoiding staphylococcal infection and reducing the duration of invasive mechanical ventilation And lethality.