摘要
目的分析重症社区获得性肺炎(SCAP)合并脓毒性休克(SS)患者临床特征及预后影响因素。方法选选取2023年1月至2024年6月上海市嘉定区安亭医院重症监护室(ICU)收治的SCAP合并SS患者174例,根据174例SCAP合并SS患者28 d预后情况分为生存组(142例)和死亡组(32例)。用Logistic回归分析筛选SCAP合并SS患者预后的影响因素。结果生存组和死亡组性别、体温、呼吸频率、心率、平均动脉压、血红蛋白、D-二聚体比较,差异无统计学意义(P>0.05);生存组和死亡组年龄、体质量指数、白细胞计数、血小板计数、血肌酐、C反应蛋白、氨基末端脑钠尿肽前体、降钙素原、凝血酶原时间、纤维蛋白原、pH、氧合指数、血乳酸、格拉斯哥评分、24 h补液量、去甲肾上腺素用量、急性生理学与慢性健康状况评分系统Ⅱ评分、英国胸科协会改良肺炎评分评分、全身性感染相关性器官功能衰竭评分评分、血管活性药物使用时间、机械通气、ICU住院时间比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,血肌酐(OR=2.693,P<0.01)、C反应蛋白(OR=5.056,P=0.001)、降钙素原(OR=6.113,P<0.01)、血乳酸(OR=6.678,P=0.001)、24 h补液量(OR=5.735,P=0.005)是SCAP合并SS患者28 d死亡的独立危险因素。结论血肌酐、C反应蛋白、降钙素原、血乳酸、24 h补液量是SCAP合并SS患者28 d死亡的独立危险因素。
Objective To analyze the clinical features and prognostic factors of patients with severe community⁃ac⁃quired pneumonia(SCAP)complicated with septic shock(SS).Methods From January 2023 to June 2024,174 patients with SCAP and SS admitted to intensive care unit(ICU),Anting hospital,Jiading district,Shanghai were gathered.Based on the 28⁃day prognosis of these patients,they were separated into a survival group(142 cases)and a death group(32 cases).Logistic regression analysis was used to screen the factors affecting the prognosis of SCAP complicated with SS patients.Re⁃sults There was no statistically significant difference between the survival group and the death group in terms of gender,body temperature,respiratory rate,heart rate,mean arterial pressure,hemoglobin,and D⁃dimer(P>0.05),however,there were statistically great differences in age,body mass index,white blood cell count,platelet count,serum creatinine,C⁃reactive protein,N⁃terminal pro⁃brain natriuretic peptide,procalcitonin,prothrombin time,fibrinogen,pH,oxygenation index,blood lactate,Glasgow score,24⁃hour fluid replacement volume,norepinephrine dosage,acute physiology and chronic health evalu⁃ationⅡscore,confusion,uremia,respiratory,BP,age 65 years score,sepsis related organ failure assessment score,duration of use of vascular active drugs,mechanical ventilation,and ICU stay(P<0.05).Logistic regression analysis showed that serum creatinine(OR=2.693,P<0.01),C⁃reactive protein(OR=5.056,P=0.001),procalcitonin(OR=6.113,P<0.01),blood lactate(OR=6.678,P=0.001),and 24⁃hour fluid replacement volume(OR=5.735,P=0.005)were independent risk factors for 28⁃day mortality in SCAP patients with SS.Conclusion Blood creatinine,C⁃reactive protein,procalcitonin,blood lactate,and 24⁃hour fluid replacement volume are independent risk factors for 28⁃day mortality in SCAP patients with SS.
作者
袁日明
杨慧
马占存
易莎
陈金中
YUAN Riming;YANG Hui;MA Zhancun;YI Sha;CHEN Jinzhong(ICU,Anting Hospital,Jiading District,Shanghai,Shanghai 201805,China)
出处
《转化医学杂志》
2024年第7期1051-1055,共5页
Translational Medicine Journal
基金
嘉定区卫生系统重点专科建设资助项目(ZK2024B02)。
关键词
重症社区获得性肺炎
脓毒性休克
临床特征
预后
影响因素
Severe community⁃acquired pneumonia
Septic shock
Clinical features
Prognosis
Influence factor
