[1]高敏,孙宇,王宇迪,等.ICU创伤后感染患者并发脓毒症的危险因素分析[J].第三军医大学学报,2017,39(04):367-372.
 Gao Min,Sun Yu,Wang Yudi,et al.Risk factors for sepsis in ICU trauma patients with infection[J].J Third Mil Med Univ,2017,39(04):367-372.
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ICU创伤后感染患者并发脓毒症的危险因素分析(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
39卷
期数:
2017年第04期
页码:
367-372
栏目:
基础医学
出版日期:
2017-02-28

文章信息/Info

Title:
Risk factors for sepsis in ICU trauma patients with infection
作者:
高敏孙宇王宇迪夏晚秋梁华平张绍蓉
第三军医大学大坪医院野战外科研究所:护理学教研室,野战外科研究所一室
Author(s):
Gao Min Sun Yu Wang Yudi Xia Wanqiu Liang Huaping Zhang Shaorong

Department of Nursing, 2State Laboratory of Trauma, Burns and Combined Injury, Department 1, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China

关键词:
脓毒症创伤感染危险因素
Keywords:
sepsis trauma infection risk factors
分类号:
R181.32;R63;R631.2
文献标志码:
A
摘要:

目的      分析重症监护病房(intensive care unit,ICU)创伤后感染患者并发脓毒症的危险因素。方法      收集2012-2015年重庆市某三级甲等教学医院综合ICU因创伤入院且发生感染的患者227例,其中男性174例,女性53例。根据患者是否并发脓毒症将其分为脓毒症组(n=168)和非脓毒症组(n=59),记录两组患者的一般资料、损伤情况、感染情况、病理生理特征等,采用SPSS 17.0统计软件分析可能导致脓毒症的相关因素。结果      创伤后感染患者脓毒症发生率为74.01%。与非脓毒症组比较,脓毒症组患者入ICU后24 h内液入量、中心置管、有创机械通气、有创机械通气持续时间、输血、血液感染、外伤创面或外科手术部位感染等较多,入院时序贯性器官功能衰竭评分(sequential organ failure score, SOFA)、损伤严重度评分(injury severity score, ISS)、新损伤严重度评分(new injury severity score, NISS)等较高(P<0.05)。经Logistic单因素和多因素逐步回归分析筛选出7个危险因素:入院时SOFA较大(OR=2.64,95%CI: 1.27~5.46,P=0.009)、入ICU时功能障碍系统的个数增加(OR=2.10,95%CI:1.35~3.27,P=0.001)、入ICU 24 h内血pH值异常(OR=3.16,95%CI:1.43~6.99, P=0.005)、入ICU 24 h内脉压差平均值增大(OR=1.52,95%CI:1.09~2.11,P=0.014)、存在葡萄球菌属感染(OR=4.32,95%CI:1.54~12.07,P=0.005)、存在外伤创面或外科手术部位感染(OR=3.73,95%CI:1.12~12.46,P=0.032)、有创机械通气持续时间增加(OR=1.94,95%CI:1.36~2.77, P<001)。结论       严密监测创伤患者入ICU 24 h内pH值及脉压差变化,预防创面及外科手术部位感染,避免葡萄球菌属感染,减少有创机械通气持续时间等,有望降低其脓毒症发生率及致死率。

Abstract:

Objective     To analyze the risk factors associated with the incidence of sepsis in intensive care unit (ICU) trauma patients with infection. Methods      A total of 227 trauma patients (174 males and 53 females) complicated by infection admitted in ICU of a Grade 3 Class A hospital from 2012 to 2015 in Chongqing were enrolled in this study. The patients were divided into sepsis group (n=168) and nonsepsis group (n=59) according to whether they were presented with sepsis. General information, injury score, infection status, and pathophysiological characteristics of all patients were recorded and analyzed using SPSS 17.0 to reveal the risk factors for sepsis. Results      The incidence of sepsis in ICU trauma patients with infection accounted for 74.01%. Within 24 h of ICU admission, the patients in sepsis group had larger infusion volume, more frequent central catheterization and invasive mechanical ventilation, longer duration of the ventilation as compared to those in the non-sepsis group. Also they were more susceptible to infection of blood, wound, or surgery with higher injury scores including sequential organ failure score (SOFA), injury severity score (ISS) and new injury severity score (NISS). The difference of these factors between the groups was statistically significant (P<0.05). Logistic regression analysis revealed 7 risk factors associated with the incidence of sepsis for ICU trauma patients. The factors were SOFA score at hospital admission (OR=2.64, 95%CI:1.27~5.46, P=0.009), increased number of dysfunctional system at ICU admission (OR=2.10, 95%CI:1.35~3.27, P=0.001), abnormal blood pH value (OR=3.16, 95%CI:1.43~6.99, P=0.005) and average increase of pulse pressure (OR=1.52, 95%CI:1.09~2.11, P=0.014) within 24 h of ICU admission, presence of staphylococcus infection (OR=4.32, 95%CI:1.54~12.07, P=0.005), presence of trauma or surgical site infection (OR=3.73, 95%CI:1.12~12.46, P=0.032), and duration of invasive mechanical ventilation (OR=1.94, 95%CI:1.36~2.77, P<0.01). Conclusion       Infection is a prerequisite for ICU trauma patients developing sepsis. Strategies such as intensive monitoring the change of pH value and pulse pressure within 24 h of ICU admission, prevention of wound and surgical site infection, avoiding staphylococcus infection, reducing the duration of mechanical ventilation and so on may potentially reduce the incidence and mortality rate of sepsis in trauma patients.

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更新日期/Last Update: 2017-02-23