本文選題：重癥監(jiān)護(hù)治療病房　切入點(diǎn)：膿毒癥　出處：《天津醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討重癥監(jiān)護(hù)治療病房膿毒癥患者預(yù)后危險(xiǎn)因素。方法:選取天津醫(yī)科大學(xué)總醫(yī)院2013年6月~2014年6月期間收入重癥監(jiān)護(hù)治療病房進(jìn)行治療且資料完整的220例膿毒癥患者為研究對(duì)象,全部患者均符合2012年SSC膿毒癥診斷指南。記錄患者的年齡、性別、基礎(chǔ)疾病、感染部位等;采集入院24h內(nèi)血常規(guī)、電解質(zhì)、動(dòng)脈血?dú)�、肝功能、腎功能等實(shí)驗(yàn)室指標(biāo),并根據(jù)感染部位,行相應(yīng)標(biāo)本進(jìn)行病原微生物培養(yǎng);入院時(shí)和入院后24h測(cè)定LAC值并計(jì)算24h乳酸清除率。以入院后24h內(nèi)指標(biāo)最差值計(jì)算急性生理和慢性健康狀況評(píng)分Ⅱ(APACHEⅡ)及SOFA評(píng)分。根據(jù)患者住院期間的預(yù)后,分為存活組與死亡組兩組。將所有數(shù)據(jù)錄入Excel系統(tǒng),并采用SPSS21.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)的處理,定量資料進(jìn)行正態(tài)的檢驗(yàn),正態(tài)分布的定量資料以均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,正態(tài)分布、方差齊的計(jì)量資料采用t檢驗(yàn),計(jì)數(shù)資料采用x2檢驗(yàn),對(duì)膿毒癥患者預(yù)后的影響因素先進(jìn)行單因素Logistic回歸分析,在單因素分析有意義基礎(chǔ)上進(jìn)行多元Logistic回歸分析。結(jié)果:(1)死亡組與存活組患者比較,在年齡、病原體感染、合并癥、衰竭臟器個(gè)數(shù)、接受抗凝治療、進(jìn)行連續(xù)性血液凈化,Lac、24h乳酸清除率、CRP、PCT、APACHEⅡ評(píng)分及SOFA評(píng)分有統(tǒng)計(jì)學(xué)意義(P0.05);在感染部位、合并心肌損傷/膿毒性腦病/急性肝損傷、基礎(chǔ)疾病、應(yīng)激性潰瘍?nèi)藬?shù)、TPN治療、機(jī)械通氣的時(shí)間、WBC、TBi L、PLT、氧合指數(shù)、ALT、CK-MB、Cr、BUN、AST、ALB、PT及PH無(wú)統(tǒng)計(jì)學(xué)意義。(P0.05)(2)單因素Logistic回歸分析顯示年齡、PCT、Lac、SOFA評(píng)分、APACHEⅡ評(píng)分、24h乳酸清除率、真菌感染、革蘭氏陰性菌感染、合并AKI/ARDS/DIC、接受抗凝治療、連續(xù)性血液凈化與ICU膿毒癥患者預(yù)后有關(guān)。(3)多元Logistic回歸分析顯示APACHEⅡ評(píng)分、24h乳酸清除率、ARDS、DIC是影響ICU膿毒癥患者預(yù)后的獨(dú)立危險(xiǎn)因素。結(jié)論:(1)ICU膿毒癥患者預(yù)后受基礎(chǔ)疾病、感染微生物、合并癥、介入治療等多種因素影響。(2)APACHEⅡ評(píng)分、24h乳酸清除率、ARDS、DIC是影響ICU患者預(yù)后的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to investigate the prognostic risk factors of sepsis patients in intensive care unit. Methods: 220 patients admitted to intensive care unit from June 2013 to June 2014 were selected for treatment in Tianjin Medical University General Hospital. Cases of sepsis were studied. All the patients were in accordance with the SSC guidelines for the diagnosis of sepsis in 2012. The patients' age, sex, underlying diseases, infection site, and so on were recorded. Blood routine examination, electrolytes, arterial blood gas, liver function, renal function and other laboratory indexes were collected within 24 hours after admission. According to the site of infection, the corresponding specimens were cultured for pathogenic microorganisms. LAC was measured at admission and 24 hours after admission, and 24h lactate clearance rate was calculated. Acute physiological and chronic health status score 鈪，

本文編號(hào)：1614444