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目的分析医院获得性肺炎继发脓毒症患者临床特征及90d生存情况,探讨影响预后因素。方法回顾性分析89例医院获得性肺炎继发脓毒症患者资料,Cox比例风险模型分别对预后行单因素与多因素分析,Kaplan-Meier法进行生存曲线比较。结果随访率100%。90d生存(OS)率为60.7%,平均生存时间64.0d(95%CI:56.5d~71.5d)。单因素分析显示影响90d OS的因素为APACHE-Ⅱ评分(P<0.001)、血Cre(P=0.003)、△PCT(P<0.001)、心搏骤停(P=0.037)、MODS(P=0.014)。多因素分析显示APACHE-Ⅱ评分(P=0.002)与△PCT(P<0.001)是影响90d OS的独立预后因素。结论医院获得性肺炎继发脓毒症患者生存率低,APACHE-Ⅱ评分与PCT变化程度是影响生存的独立因素。
Objective To analyze the clinical features and survival of patients with sepsis secondary to hospital acquired pneumonia and to explore the prognostic factors. Methods The data of 89 patients with sepsis secondary to hospital acquired pneumonia were retrospectively analyzed. Cox proportional hazard model was used to analyze single and multifactorial prognostic factors, respectively. Kaplan-Meier survival curves were compared. Results The follow-up rate was 100%. The 90-day OS rate was 60.7% and the mean survival time was 64.0 days (95% CI: 56.5d-71.5d). Univariate analysis showed that the factors affecting the 90-day OS were APACHE-Ⅱ score (P <0.001), blood Cre (P = 0.003), △ PCT (P <0.001), cardiac arrest (P = 0.014). Multivariate analysis showed that APACHE-Ⅱ score (P = 0.002) and △ PCT (P <0.001) were the independent prognostic factors for 90-day OS. Conclusion The survival rate of patients with sepsis secondary to hospital-acquired pneumonia is low. The APACHE-Ⅱ score and the degree of PCT change are independent factors that affect survival.