脓毒症并发胃肠道功能不全综合征的临床危险因素分析

目的：研究脓毒症患者并发胃肠道功能不全综合征（GIDS）的临床特点及相关危险因素.方法：回顾性分析2010年10月30日-2012年10月30日间北京市海淀医院ICU中收治的110例脓毒症患者的临床资料.根据是否发生以肠内喂养不耐受（FI）、胃肠道出血（GIH）和麻痹性肠梗阻（PI）为主要表现的GIDS,将患者分为GIDS组和非GIDS组,记录其性别、年龄和入院24 h时的病情、实验室检查等25项指标,观察预后（ICU住院时间及病死率）.对上述资料进行单因素分析及多因素非条件Logistic回归分析,筛选出脓毒症并发GIDS的高危因素.结果：共有72例脓毒症患者（65.5%）发生GIDS,其中,以FI 合并PI的发生率最高,为45.9%.同非GIDS患者相比,GIDS患者ICU病死率更高（47.2% 比21.1%,P=0.007）,住ICU时间更长（18.6±13.6）d比（14.2±7.8）d,P=0.035）;Logistic回归分析显示,年龄（OR=1.958,95%CI 1.925～1.992,P=0.016）、血C反应蛋白（OR=1.136,95%CI 1.051～1.229,P=0.001）和早期应用儿茶酚胺类药物（OR=6.016,95%CI 2.225～16.263,P=0.000）是脓毒症患者发生GIDS的独立危险因素并能预测GIDS的发生.结论：GIDS是脓毒症常见的并发症,并影响患者的预后;高龄、血C反应蛋白水平升高和早期应用儿茶酚胺类药物的脓毒症患者发生GIDS的风险较高.

Analysis on risk factors associated with gastrointestinal dysfunction syndrome in patients with sepsis

Objective：To study the clinical characteristics of gastrointestinal dysfunction syndrome （GIDS） in patients with sepsis. Methods：The data of 110 cases with sepsis admitted to intensive care unit （ICU） of Peking Haidian Hospital during 30th October 2010 to 30th October 2012 were retrospectively analyzed. GIDS was defined as documented gastroin testinal problems （food intolerance, gastrointestinal haemorrhage, and/or paralytic ileus） in their medical records during their stay in the ICU. Twenty-five factors of the demographic characteristics such as age, sex, as well as degree of severity within 24 hours of admission, laboratory indexes etc. were recorded, and ICU stay time and mortality rate were also taken into account. Simple logistic regression, multivariate and unconditioned regression were used to determine the risk factors of GIDS in patients with sepsis. Results：Among 110 cases, GIDS occurred in 72 patients （65.5 %）. Among the three symptoms of GIDS, the incidence of food intolerance combined with paralytic ileus was the highest （45.9 %）. GIDS was significantly related to higher mortality （47.2 ~ vs. 21.1 ~ in patients without GIDS, P-0. 007）, as well as longer length of ICU stay （18. 6＋13.6）days vs. （14. 2±7.8） days] in patients without GIDS, P 0. 035）, in patients with sepsis. I.ogistic regression analysis showed that higher age （OR= 1. 958.95 % CI 1. 925 - 1. 992, P 0.016）, increased plasma levels of C-reactive protein （OR= 1. 136.95 %CI 1. 051-1. 229 ,P= 0. 001）, and the use of catecholamine drugs （OR=6. 016,95%CI 2. 225- 16. 263, P= 0. 000） were the independent risk factors for GIDS in patients with sepsis. Conclusions：GIDS in patients with sepsis represents a relevant clinical problem accompanied by an increase in mortality, and longer length of ICU stay. The patients in sepsis with higher age, increase in plasma levels of C-reactive protein, and the use of catecholamine drugs are susceptible to the complication of GIDS.