1991～2001年ICU感染性休克病死危险因素分析及临床对策

目的调查感染性休克病死率和病死危险因素。方法回顾性调查1991～2001年的143例感染性休克患者，计算逐年病死率，采用单因素分析和多因素逐步logistic回归，分析感染性休克病死危险因素。结果1991～2001年问，143例感染性休克患者总病死率69．2％(99／143)，11年间病死率无显著变化(P=0．238)。感染性休克患者合并循环外器官功能衰竭数目增多，病死率增加。单纯循环衰竭者病死率46．7％(8／15)，合并1个循环外器官衰竭者病死率48．3％(14／29)，2个循环外器官衰竭者70．6％(24／34)，当感染性休克患者合并3个以上循环外器官衰竭者，病死率高达85．7％(24／28)以上。多因素逐步logistic回归显示，感染性休克的病死危险因素是合并器官功能衰竭数目。结论11年间，感染性休克的病死率无明显下降，防止器官功能损害是降低感染性休克病死率的关键。

An analysis of risk factors and clinical strategies in ICU patients with septic shock during 1991 to 2001

Objective To study the mortality and risk factors in critically ill patients with septic shock.Methods 143 critically ill patients with septic shock were studied retrospectively.Stepwise logistic regression analysis was performed to identify risk factors associatied with septic shock.Results The overall mortality of septic shock was 69 2%(99/143).The fatality showed no significant change from 1991 to 2001( P =0 238).The mortality of patients with circulatory failure alone was 46 7%(8/15).However,the mortality in patients of septic shock associated with one,two or three organ failure were 48 3%,70 6% and 85 7%.In stepwise logistic regression analysis,the number of failed organ was the risk factor associated with death.Conclusion The mortality of septic shock showed no trend of decline since 1991.Prevention of organ function impairment may play a key role in decreasing mortality of septic shock in critically ill patients.