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目的:探讨影响ICU重度脓毒症患者死亡的危险因素,为今后重度脓毒症的防治提供依据。方法:应用回顾性调查的方法,对我院ICU病房2006年1-12月收治的75例重度脓毒症患者进行统计学分析。结果:重度脓毒症患者死亡组Marshall评分、急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)均明显高于存活组(P<0.001或P<0.005)。随着器官功能不全的数目增加,患者28d病死率、3个月病死率均明显增高,Spearman等级相关分析显示28d病死率及3个月病死率均与器官功能不全数明显相关(P<0.001)。Logistic回归分析显示脓毒症休克(P<0.005)、中枢神经系统功能不全(P<0.05)、APACHEⅡ评分(P<0.05)是重度脓毒症患者28d死亡的独立危险因素,脓毒症休克(P<0.005)、器官功能不全数目(P<0.05)、患有慢性疾病(P<0.05)是重度脓毒症患者3个月死亡的独立危险因素。结论:器官功能不全、脓毒症休克、APACHEⅡ评分、是否患有慢性疾病对判断ICU重度脓毒症患者的预后有一定指导意义。
Objective: To investigate the risk factors of death in patients with severe sepsis in ICU and provide basis for the prevention and treatment of severe sepsis in the future. Methods: A retrospective survey was performed to analyze 75 patients with severe sepsis admitted to ICU ward in January-December 2006. Results: Marshall score, acute physiology and chronic health status score Ⅱ (APACHE Ⅱ) in death group were significantly higher than those in survival group (P <0.001 or P <0.005). As the number of organ dysfunction increased, the 28-day mortality rate and 3-month mortality rate were significantly increased. Spearman rank correlation analysis showed that the 28-day mortality rate and 3-month mortality rate were significantly associated with organ dysfunction (P <0.001) . Logistic regression analysis showed that septic shock (P <0.005), central nervous system insufficiency (P <0.05), and APACHEⅡscore (P <0.05) were independent risk factors for 28-day mortality in severe sepsis patients, septic shock P <0.005), organ dysfunction (P <0.05), and chronic disease (P <0.05) were independent risk factors for 3-month mortality in severe sepsis. CONCLUSIONS: Organ dysfunction, septic shock, APACHEⅡscore, and chronic disease have some guiding significance in judging the prognosis of ICU patients with severe sepsis.