赵伟丽　苏彩燕　　娄敏燕　　孙伟

[摘要] 目的 探討影响ICU脓毒症患者预后的高危因素分析。 方法 选择2018年1月至2019年12月在我院ICU接受治疗的脓毒症患者160例为研究对象，根据患者预后分为存活组96例，死亡组64例。记录患者的年龄、性别、是否机械通气、ICU入住时间、感染性休克、器官衰竭个数、有创血流动力学监测、输血、确诊时APACHEⅡ评分、SOFA评分、MEDS评分、确诊时血清PCT水平、CRP水平、D-二聚体水平、血乳酸水平（LAC）。单因素及多因素分析影响患者预后的相关因素。 结果 单因素分析结果显示，机械通气、ICU感染、急性肾衰竭、器官衰竭个数>2个，感染性休克、有创血流动力学监测、输血的患者死亡率更高，差异有统计学意义（P<0.05）;死亡组APACHEⅡ评分、SOFA评分、MEDS评分、PCT、CRP、D-二聚体、LAC显著高于存活组，ICU入住时间显著长于存活组，差异有统计学意义（P<0.05）。多因素分析结果显示，APACHEⅡ评分、SOFA评分、MEDS评分、PCT水平、D-二聚体水平、LAC水平、急性肾衰竭、器官衰竭个数、感染性休克是ICU脓毒症患者预后的独立影响因素（P<0.05）。 结论 ICU脓毒症患者病情危重，死亡率较高，患者确诊时APACHEⅡ评分、SOFA评分、MEDS评分、PCT水平、D-二聚体水平、LAC水平、急性肾衰竭、器官衰竭个数、感染性休克是影响其预后的独立危险因素，在临床工作中应充分重视、注意监测，以辅助判断患者的病情变化。

[关键词] ICU;脓毒症;预后;高危因素

[中图分类号] R631          [文献标识码] A          [文章编号] 1673-9701（2021）12-0031-04

Analysis of high-risk factors impacting prognosis of ICU sepsis patients

ZHAO Weili1 SU Caiyan1 LOU Minyan2 SUN Wei3

1.Department of Critical Care Medicine， Taizhou Hospital of Zhejiang Province， Linhai   317000， China; 2.Department of Geriatrics， Taizhou Hospital of Zhejiang Province， Linhai 317000， China; 3.Department of Emergency， Taizhou Hospital of Zhejiang Province， Linhai   317000， China

[Abstract] Objective To investigate the high-risk factors impacting prognosis of ICU sepsis patients. Methods A total of 160 patients with sepsis who were admitted to ICU of our hospital from January 2018 to December 2019 were selected as the research objects. Patients were divided into the survival group （n=96） and the mortality group （n=64） according to prognosis. The age， gender， mechanical ventilation， average hospitalization time in ICU， septic shocks， number of organ failures， invasive hemodynamic monitoring， blood transfusion， APACHEⅡ score， SOFA score， MEDS score， serum PCT level， CRP level， D-dimer level and blood lactate acid level（LAC） at diagnosis were recorded. Univariate and multivariate analysis of related factors impacting the prognosis of patients were performed. Results Univariate analysis showed that the mortality rate of patients with mechanical ventilation， ICU infection， acute renal failure， more than two organs failure， septic shock， invasive hemodynamic monitoring and blood transfusion were statistically significant higher（P< 0.05）. The APACHEⅡ score， SOFA score， MEDS score， PCT， CRP， D-dimer and LAC level in the mortality group were statistically significantly higher than those in the survival group， the hospitalization time in ICU were significantly statistically longer than those in the survival group（P<0.05）. Multivariate analysis showed that APACHEⅡ score， SOFA score， MEDS score， PCT level， D-dimer level， LAC level， acute renal failures， number of organ failures and septic shocks were independent impacting factors on prognosis of ICU sepsis patients（P<0.05）. Conclusion Patients with sepsis in ICU are in critical condition with high mortality rate. APACHEⅡ score， SOFA score， MEDS score， PCT level， D-dimer level， LAC level， acute renal failure， organ failure number and septic shock at diagnosis are independent risk factors impacting the prognosis of patients， which should be paid full attention to and monitored in clinical work to help judge the changes of patients′ condition.

[Key words] ICU; Sepsis; Prognosis; High-risk factor

脓毒症是人体对感染反应失调导致的器官功能障碍综合征，主要表现为寒战、发热（低体温）、心慌、气促、精神状态改变等。脓毒症可发展为严重脓毒症及脓毒症休克，导致器官功能不全及循环障碍，具有较高的病死率。通常当脓毒症患者病情进展，发展为严重脓毒症和脓毒症休克时，出现生命体征不稳定，患者需要入住ICU进行高级生命支持，因此，与普通病房的脓毒症患者相比，ICU脓毒症患者病情更重、预后更差。既往研究结果显示，血清PCT水平在一定程度上可以反映脓毒症患者病情的严重程度，并可预测患者预后。另外，患者年龄SOFA评分及APACHEⅡ评分等是预后的独立危险因素[1]。此外，也有研究结果显示，尿素氮、血肌酐、机械通气、脓毒症休克、器官衰竭个数等均对患者预后产生影响[2]。掌……