急诊脓毒症患者预后的相关因素分析

doi:10.3969/j.issn.1002-1949.2019.03.012

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摘要目的分析急诊科脓毒症患者的流行病学特点、入院时的实验室检查资料特征，探讨影响急诊脓毒症患者28 d生存率的相关因素。方法收集2017年1月至2018 年4月期间西安交通大学第二附属医院经急诊科收治的脓毒症患者302例，根据28 d预后分为生存组238例和死亡组64例。统计性别、年龄、报销方式、基础疾病、住院时间、预后、入院时的实验室检查资料、快速器官衰竭（qSOFA）评分、序贯器官衰竭评估（SOFA）评分、急性生理与慢性健康状况Ⅱ（APACHEⅡ）评分等数据，并作预后分析。结果单因素分析发现年龄，入院当天最高脉搏、呼吸频率，最低平均动脉压、SOFA评分、qSOFA评分、APACHEⅡ评分，生化、凝血相关指标及入院后的治疗与预后相关，生存组与死亡组比较差异有统计学意义。生存组年龄（58.36±20.19）岁，低于死亡组（68.03±17.49）岁（P=0.317）。生存组住院时间（14.97±10.98）d，高于死亡组（6.03±7.23）d（P<0.001）。多因素Logistic回归分析显示，住院时间和入院当天SOFA评分与脓毒症28 d生存率相关，OR值分别为0.89（0.82,0.96）和1.40（1.22,1.59）。ROC曲线分析显示，SOFA评分对脓毒症28 d生存率具有较高预测价值，ROC曲线下面积为0.84（0.78,0.90），临界值为8分，敏感度为72%，特异度为83%。结论 SOFA评分可用于脓毒症患者的预后评估，在诊疗过程中动态评估，有利于掌握患者病情，给予患者最合适的诊疗。

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	吕俊华
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	王丹
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	王海

关键词 ：脓毒症, 影响因素, 快速器官衰竭（qSOFA）评分, 序贯器官衰竭评估（SOFA）评分, 急性生理与慢性健康状况Ⅱ（APACHEⅡ）评分, 预后

通讯作者: 王海（1987-），男，硕士，住院医师，E-mail:470050727@qq.com。

作者简介: 吕俊华(1992-)，女，硕士研究生在读，E-mail:2015699854@qq.com。

引用本文:

吕俊华,时雨，王丹，裴红红，王海. 急诊脓毒症患者预后的相关因素分析[J]. 中国急救医学, 2019, 39(3): 260-263.
Lv Jun-hua, Shi Yu, Wang Dan, Pei Hong-hong, Wang Hai. Analysis of prognostic factors in ED patients with sepsis. Chinese Journal of Critical Care Medicine, 2019, 39(3): 260-263.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.03.012 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I3/260

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