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目的讨论重症医学科(ICU)内系统性红斑狼疮(SLE)合并脓毒症患者的临床特点和预后的影响因素。方法回顾分析2010~2014年入住ICU的SLE合并脓毒症的临床及实验室数据包括主要器官受累情况,SLE疾病活动指数(systemic lupus erythematosus disease activity index,SLEDAI),急性生理和慢性健康状况评分(acute physiology and chronic health evaluation,APACHEⅡ),感染部位及病原体检查结果等,并采用多因素logistic回归分析预后相关的危险因素。结果共纳入50例患者,以女性为主(86%),SLEDAI(15.8±6.3)分,APACHEⅡ(25.8±6.5)分,ICU内死亡率为46.0%,最常见的死亡原因为多器官衰竭,进入ICU的最常见原因是呼吸衰竭。感染以G-菌为主。多变量logistic回归提示ICU内消化道出血、感染性休克及较高的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)与预后相关。结论消化道出血、感染性休克和较高的APACHEⅡ评分是ICU内SLE合并脓毒症患者预后的不良因素。
Objective To discuss the clinical characteristics and prognosis of patients with systemic lupus erythematosus (SLE) complicated with sepsis in intensive care unit (ICU). Methods The clinical and laboratory data on SLE with sepsis admitted to the ICU between 2010 and 2014 were retrospectively analyzed. The data included major organ involvement, systemic lupus erythematosus disease activity index (SLEDAI), acute physiology and chronic health status score acute physiology and chronic health evaluation, APACHEⅡ), infection site and pathogen test results. Multivariate logistic regression was used to analyze the risk factors related to prognosis. Results A total of 50 patients were enrolled in this study. The main causes of death were multiple organ failure (86%), SLEDAI (15.8 ± 6.3) and APACHEⅡ (25.8 ± 6.5), with an ICU mortality rate of 46.0% The most common reason to enter the ICU is respiratory failure. Infection with G-bacteria-based. Multivariate logistic regression suggested that intra-ICU gastrointestinal bleeding, septic shock, and higher acute physiology and chronic health status score system Ⅱ (APACHEⅡ) were associated with prognosis. Conclusions Gastrointestinal hemorrhage, septic shock and high APACHEⅡscore are the adverse prognostic factors in patients with SLE complicated with sepsis.