摘要
目的探讨急诊科脓毒症脑病患者的临床诊疗及预后分析。方法选取清华大学附属垂杨柳医院急诊科2020年1月至2021年12月收治的131例脓毒症脑病患者的病例资料,分为存活组和死亡组。采用logistic回归方法分析影响脓毒症脑病患者诊疗及预后的危险因素。采用受试者工作特征(ROC)曲线评价各项检测指标预测脓毒症脑病患者预后的价值。结果死亡组平均动脉压(MAP)、pH水平低于存活组,血C反应蛋白(CRP)、肌钙蛋白T(TNI)、D-二聚体、乳酸、肌酐、急性生理学与慢性健康状况评分系统(APACHEⅡ)、序贯器官衰竭评分(SOFA)、使用呼吸机支持比例、使用血管活性药物比例高于存活组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,APACHEⅡ评分(OR=1.290,95%CI:1.121~1.485,P<0.001)、SOFA评分(OR=1.447,95%CI:1.183~1.796,P<0.001)、使用血管活性药物比例(OR=18.720,95%CI:4.486~78.108,P<0.001)可以预测脓毒症脑病患者预后,曲线下面积(AUC)分别为0.823、0.886、0.787。结论高龄及基础脑疾患是脓毒症脑病发生的重要因素,APACHEⅡ评分、SOFA评分、使用血管活性药物使用比例可以预测脓毒症脑病患者预后。
Objective To investigate the clinical diagnosis and prognosis in patients with emergency septic encephalopathy.Methods Case data of 131 patients with septic encephalopathy admitted to the emergency department of Chuiyangliu Hospital Affiliated to Tsinghua University from January 2020 to December 2021 were selected and divided into survival group and death group.Logistic regression was used to analyze the risk factors affecting diagnosis,treatment and prognosis in patients with septic encephalopathy.Receiver operating characteristic(ROC)curve was used to evaluate the prognostic value of each indicator in patients with septic encephalopathy.Results The mean arterial pressure(MAP)and pH level in the death group were lower than those in the survival group,while the C reactive protein(CRP),troponin T(TNI),D-dimer,lactic acid,creatinine,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)score,Sequential Organ Failure Assessment(SOFA),proportion of ventilator support,proportion of vasoactive drug use in the death group were higher than those in the survival group,with statistically significant difference(all P<0.05).Multivariate logistic regression analysis showed that APACHEⅡ score(OR=1.290,95%CI:1.121-1.485,P<0.001),SOFA score(OR=1.447,95%CI:1.183-1.796,P<0.001),the proportion of vasoactive drug use(OR=18.720,95%CI:4.486-78.108,P<0.001)could predict the prognosis of patients with septic encephalopathy,and the area under the curve(AUC)was 0.823,0886,0.787.Conclusions Elderly age and underlying brain diseases are important factors in the occurrence of septic encephalopathy.APACHEⅡ score,SOFA score,and the proportion of vasoactive drug use can predict the prognosis of patients with septic encephalopathy.
作者
钟洁
潘兴邦
顾伟
Zhong Jie;Pan Xingbang;Gu Wei(Department of Emergency Medicine,Chuiyangliu Hospital Affiliated to Tsinghua University,Beijing 100023,China)
出处
《中国医师杂志》
CAS
2023年第4期551-554,共4页
Journal of Chinese Physician
基金
北京市科技计划课题(Z221100007422129)。
关键词
脓毒症相关性脑病
昏迷
急诊
Sepsis-associated encephalopathy
Coma
Emergency
