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目的 探讨感染性休克的诊断。方法 回顾性分析外科重症监护病房 (SICU ) 1996～ 1999年收治的40例感染性休克病人的临床和实验室资料 ,探讨感染性休克发生的危险因素及诊断上的若干问题。结果 高龄、腹腔感染、两个或两个以上部位感染、广谱抗生素应用、APACHEⅡ积分在 8分以上、脏器功能不全和血清内TNFα增高是感染性休克发生的危险因素。 17例血标本PCR检测细菌DNA的阳性率为 10 0 %。细菌分布以G-杆菌为主 ,占 5 8 1% ;霉菌感染率占 7 2 %。感染性休克病人血清内的TNFα活性显著升高。结论 具有高危因素的全身性感染病人应注意预防感染性休克的发生 ;采用PCR技术检测有助于感染源的诊断 ;腹部外科感染性休克的感染源调查提示抗生素经验性治疗主要应针对G-杆菌和真菌。
Objective To investigate the diagnosis of septic shock. Methods The clinical and laboratory data of 40 septic shock patients admitted to the SICU from 1996 to 1999 were retrospectively analyzed to explore the risk factors and some problems in the diagnosis of septic shock. The results of elderly, abdominal infection, two or more parts of the infection, broad-spectrum antibiotics, APACHE Ⅱ points in more than 8 points, organ dysfunction and serum TNFα increased risk of septic shock. The positive rate of bacterial DNA detected by PCR in 17 blood samples was 100%. Bacterial distribution was mainly G-bacilli, accounting for 58.1%; mold infection rate was 72%. Septic shock in patients with serum TNFα activity was significantly increased. Conclusion Patients with systemic infection with high risk factors should pay attention to prevent the occurrence of septic shock; PCR technique can be used to diagnose the source of infection; Survival analysis of septic shock in abdominal surgery suggests that the empirical treatment of antibiotics should focus on G- And fungi.