不同时期ICU脓毒症患者临床特征及转归分析

目的:分析不同时期ICU脓毒症患者临床特征及治疗转归。方法:采用前瞻法研究,与历史病例进行对照比较研究;前瞻性观察组(前瞻组)为2010年1月至2011年12月ICU脓毒症患者,历史对照组(对照组)为2006年1月至2007年12月ICU的脓毒症患者,前瞻组401例,对照组285例,组内按疾病严重程度再分为普通脓毒症、严重脓毒症、脓毒症休克3层;前瞻组在诊断脓毒症后最初6 h内作早期目标性复苏(EGDT)等治疗,对照组通过查阅病历采集数据。结果:两组普通脓毒症、严重脓毒症、脓毒症休克病例的APACHEⅡ评分与疾病严重程度呈正相关(P<0.01);前瞻组严重脓毒症、脓毒症休克患者住ICU天数、病死率低于对照组(P<0.05);两组脓毒症感染部位均依次为呼吸系统、腹腔、血液及其他部位,血液感染脓毒症病死率居首位;前瞻组总病死率低于对照组(P<0.05)。结论:脓毒症是ICU主要收治病种,病死率高;对严重脓毒症、脓毒症休克患者进行早期积极规范的综合治疗可以降低该类患者的病死率。

Analysis of clinical characteristics and treatment outcomes of patients with sepsis in the different periods in ICU

Objective: To analyze the clinical features and treatment outcomes of sepsis in the different periods in ICU.Methods: Observing the sepsis patients with a prospective design,and comparing with the historical cases.The prospective observational sepsis group(prospective group) cases were collected from January 2010 to December 2011,and historical control group(control group) cases were gathered from January 2006 to December 2007.There were 401 cases in the prospective group and 285 cases in the control group.According to the severity of sepsis,the cases were divided into general sepsis,severe sepsis and septic shock three levels.Prospective group were treated with the early goal-directed therapy(EGDT) and other measurement within 6 hours after the diagnosis of sepsis,control group data was gathered from medical historical records.Results: The APACHE II score was positively correlated to the severity of sepsis(P<0.01).The days staying in ICU and mortality rates of patients of severe sepsis,septic shock in prospective group were lower than those in the control group(P<0.05).The sites of infection in two groups were followed by respiratory,abdominal cavity,blood and other parts.The top mortality of sepsis was the blood infection.The total mortality rate in prospective group was lower than that in the control group(P<0.05).Conclusion: Sepsis patients are the main target who needs to be treated in ICU for its severity and high mortality.An active regulatory early treatment can reduce mortality of patients with severe sepsis and septic shock.