内科理论与实践

内科理论与实践 ›› 2022, Vol. 17 ›› Issue (04): 278-282.doi: 10.16138/j.1673-6087.2022.04.002

• 论著 • 上一篇    下一篇

综合性医院674例脓毒症住院患者的回顾性临床分析

郑毓真, 郑彦俊, 周易, 祁星, 陈薇薇, 史雯(), 周伟君, 杨之涛, 陈影, 毛恩强, 陈尔真   

  1. 上海交通大学医学院附属瑞金医院急诊医学科,上海 200025
  • 收稿日期:2021-03-31 出版日期:2022-07-18 发布日期:2022-08-08
  • 通讯作者: 史雯 E-mail:lotus_247@163.com
  • 基金资助:
    国家自然科学基金项目(81772107);第二轮《促进市级医院临床技能与临床创新三年行动计划（2020-2022年）》重大临床研究项目(SHDC 2020CR1028B);第二轮《促进市级医院临床技能与临床创新三年行动计划（2020-2022年）》重大临床研究项目(SHDC2202134);2017年上海领军人才项目

The clinical retrospective analysis of 674 hospitalized patients diagnosed with sepsis in a general hospital

ZHENG Yuzhen, ZHENG Yanjun, ZHOU Yi, QI Xing, CHEN Weiwei, SHI Wen(), ZHOU Weijun, YANG Zhitao, CHEN Ying, MAO Enqiang, CHEN Erzhen   

  1. Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2021-03-31 Online:2022-07-18 Published:2022-08-08
  • Contact: SHI Wen E-mail:lotus_247@163.com

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摘要：

目的： 探讨综合性医院脓毒症住院患者的流行病学特点及其死亡危险因素。方法： 回顾性分析2018年1月1日至2019年12月31日期间上海交通大学医学院附属瑞金医院收治的脓毒症患者病历资料,分为死亡组和生存组,对比2组的临床特点差异,并采用多因素Logistic回归分析影响住院死亡率的危险因素。结果： 共674例患者纳入研究,其年龄中位数为65岁,男性437例（64.8%）,住院时间中位数为23 d,死亡率31.5%。糖尿病（20.8%）及肿瘤（15.0%）为最常见的基础合并症。患者最常见的感染部位为腹部（43.6%）;死亡组最常见的感染部位为呼吸道（54.2%）,血培养最常见的分离菌株为肺炎克雷伯杆菌（30.6%）。年龄≥60岁、低体重、来源于内科病房、器官衰竭数量≥3个、脓毒性休克及序贯器官衰竭评估（sequential organ failure assessment,SOFA）评分增加是脓毒症死亡的独立危险因素。结论： 年龄、体质量指数、器官衰竭数及脓毒性休克等是影响脓毒症死亡率的主要因素。

关键词: 脓毒症, 流行病学, 住院患者, 危险因素

Abstract:

Objective To investigate the epidemiological characteristics and mortality risk factors of the inpatients diagnosed with sepsis in a general hospital. Methods The patients admitted to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from January 1st,2018 to December 31st, 2019 were enrolled and the retrospective study was conducted on the patients diagnosed with sepsis. The patients were divided into survival group and dead group, and their clinical data were analyzed and compared. The Logistic regression analysis was used to identify independent risk factors of death in the patients during hospitalization. Results A total of 674 patients (75.7%) diagnosed with sepsis were included in the study. Most of patients were male (64.8%) and the median age was 65 years. The median length of hospital stay was 23 d. The hospital mortality was 31.5%. The diabetes mellitus(20.8%) was the most common comorbid disease and followed by tumor (15.0%）. The most common site of infection was abdomen (43.6%) and the highest proportion in microorganisms isolated from positive blood cultures was Klebsiella pneumoniae (30.6%). Respiratory tract infection was the main infection site in deceased patients. Through Logistic regression analysis, the independent risk factors of hospital mortality were identified, which were age ≥60 years, low weight, admission from internal medicine wards, multiple organ failure, septic shock and increasing sepsis-related organ failure assessment(SOFA). Conclusions The factors affecting the in-hospital mortality were older age, low weight, multiple organ failure and septic shock.

Key words: Sepsis, Epidemiology, Inpatients, Risk factors

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