EICU脓毒性休克患者的临床特点及死亡危险因素分析

目的探讨急诊危重病监护室(EICU)脓毒性休克患者临床特点及死亡相关危险因素。方法回顾性调查2003年1月～2009年1月间入住笔者医院急诊科EICU的159例脓毒性休克患者临床资料,总结患者临床特点,采用单因素分析和多因素逐步Logistic回归,分析脓毒性休克死亡相关危险因素。结果 159例脓毒性休克患者中,男性96例(60.4%),女性63例(39.6%),平均年龄57.9±16.3岁,器官功能衰竭数目3.38±1.57个,腹部是最常见感染部位(45.3%),心血管系统疾病(38.4%)是最常见的基础疾病;总病死率53.5%(85/159),男性病死率高于女性(60.4%vs 42.9%,P<0.05);多因素逐步Lo-gistic回归显示:合并器官功能衰竭数目、静脉使用碳酸氢钠是脓毒性休克的死亡独立危险因素,血液净化及住院时间是保护因素。结论脓毒性休克的病死率极高,早期积极抢救,运用血液净化等多种抢救措施,防治器官功能衰竭是降低脓毒性休克病死率的关键。

Mortality and Risk Factors of Septic Shock in 159 Patients in Emergency Intensive Care Unit

Objective To analyze the clinical characteristics and the mortality and risk factors of septic shock in Emergency Intensive Care Unit.Methods The clinical data of 159 patients with septic shock hospitalized in EICU from January 2003 to January 2009 were studied retrospectively.Stepwise logistic regression analysis was performed to identify risk factors associated with septic shock.Results There were 96 males and 63 females with mean ages 57.88±16.30 years old.The mean number of organ failure was 3.38±1.57.The abdomen was the most common site of infections(45.3%).Comorbidities were found in 78.6% of patients,and the most common was cardiovascular diseases(38.4%).The overall mortality of septic shock was 53.5%(85/159).The mortality of male was higher than that of female(60.4% vs 42.9%,P<0.05).In stepwise logistic regression analysis,the number of failed organ and using of sodium bicarbonate were the risk factor associated with death.Hemopurification and length of stay were the protective factor.Conclusion The mortality of septic shock is extreme high.Early and active resure,the use of hemopurification and other rescue measures to prevent organ function impairment may play a key role in decreasing mortality of septic shock.