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目的探讨脓毒性休克患者急性静脉血栓栓塞(VTE)的危险因素及预后。方法选取116例脓毒性休克患者为研究对象,统计VTE的发病情况,采用单因素和Logistic多因素分析法分析脓毒性休克患者发生VTE的危险因素,比较不同VTE发生情况患者的APACHEⅡ评分和预后情况,并采用Spearman秩相关分析法分析脓毒性休克患者VTE发生率与其APACHEⅡ评分和预后的关系。结果 VTE的发生率为37.07%(43/116),且与无VTE患者比较,发生VTE患者的年龄较大、住院和机械通气时间较长、气管插管率提高,差异有统计学意义(P<0.05)。进一步Logistic多因素分析法分析结果显示,住院时间、机械通气时间及气管插管率均为脓毒性休克患者VTE的独立危险因素。VTE患者治疗前后的APACHEⅡ评分及28 d病死率均高于无VTE患者(P<0.05)。Spearman秩相关分析结果显示,脓毒性休克患者VTE的发生及APACHEⅡ评分与28 d病死率均呈正相关(r=0.748、0.856,P<0.05)。结论脓毒性休克患者VTE的发病率较高,且住院时间、机械通气时间及气管插管率均为其独立危险因素,脓毒性休克患者发生VTE及病情均与预后相关。
Objective To investigate the risk factors and prognosis of acute venous thromboembolism (VTE) in patients with septic shock. Methods One hundred and sixty-one patients with septic shock were enrolled in this study. The incidence of VTE was calculated. The risk factors of VTE in patients with septic shock were analyzed by single factor and logistic multivariate analysis. The APACHEⅡscore and prognosis of patients with different VTE were compared Spearman rank correlation analysis was used to analyze the relationship between VTE incidence and APACHE II score and prognosis in patients with septic shock. Results The incidence of VTE was 37.07% (43/116). Compared with patients without VTE, the incidence of VTE was longer, hospitalization and mechanical ventilation were longer, and tracheal intubation rate was increased with a statistically significant difference (P <0.05). Further analysis of Logistic multivariate analysis showed that hospital stay, mechanical ventilation time and endotracheal intubation rate were independent risk factors for VTE in patients with septic shock. The APACHE II score before and after treatment in patients with VTE and the mortality at 28 days were higher than those without VTE (P <0.05). Spearman rank correlation analysis showed that the occurrence of VTE and the APACHEⅡscore in septic shock patients were positively correlated with the 28-day mortality (r = 0.748,0.856, P <0.05). Conclusion The incidence of VTE in patients with septic shock is higher than that in patients with septic shock. The duration of hospital stay, the time of mechanical ventilation and the rate of endotracheal intubation are independent risk factors. The occurrence of VTE and the prognosis of patients with septic shock are related to the prognosis.