Risk factors for nosocomial infection and death in patients with sepsis
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摘要: 目的 研究脓毒症医院感染和死亡危险因素,对脓毒症快速诊断和早期治疗提供参考。 方法 收集2014年1月-2015年6月宁波市第一医院收治的脓毒症患者74例,分析22项相关因素与脓毒症医院感染和死亡的关系。 结果 脓毒症医院感染与年龄、脓毒性休克、APACHEⅡ评分 ≥ 20分、SOFA评分 ≥ 2分、手术持续时间、使用糖皮质激素、中心静脉插管、3种以上导管、2种以上细菌感染、感染持续时间 ≥ 5 d及住院时间<20 d共11项危险因素有关,临床应加强对上述11项因素的监测,早期发现脓毒症医院感染并采取积极的治疗措施。脓毒症死亡与年龄、糖尿病史、脓毒性休克、APACHEⅡ评分 ≥ 20分、SOFA评分 ≥ 2分、血糖 ≥ 8.3 mmol/L、手术持续时间 ≥ 3 h、术中出血量、3种以上导管、2种以上细菌感染、感染持续时间<5 d、住院时间<20 d共12项危险因素有关,临床应密切监测具有上述12项危险因素的患者病情变化情况,采取有效治疗措施,降低患者病死率。脓毒性休克、APACHEⅡ评分 ≥ 20分、SOFA评分 ≥ 2分、3种以上导管、2种以上细菌感染等5项因素是脓毒症医院感染和死亡共同的危险因素,对具有上述5项因素的患者,应转入ICU加强治疗。 结论 符合脓毒性休克、APACHEⅡ评分 ≥ 20分、SOFA评分 ≥ 2分、3种以上导管、2种以上细菌感染这5项共同危险因素的患者应引起临床高度重视,积极治疗,改善预后。APACHEⅡ评分 ≥ 20分和SOFA评分 ≥ 2分的患者应立即进行抗感染治疗,启动脓毒症规范化治疗流程。脓毒症死亡多集中于感染5 d内,早期诊断和治疗对脓毒症预后极其重要。Abstract: Objective To research the risk factors for nosocomial infection and death in patients with sepsis and provide reference for the rapid diagnosis and early treatment of sepsis. Methods A total of 74 patients with sepsis admitted to hospital from January, 2014 to June, 2015 were collected to analyze the relationship between nosocomial infection and mortality in 22 related factors. Results Nosocomial infection in sepsis patients was related to 11 risk factors:age, septic shock, APACHE score ≥ 20 points, SOFA score ≥ 2 points, duration of operation, use of corticosteroids, central venous catheterization, more than three catheterizations, more than 2 kinds of bacterial infection, duration of infection ≥ 5 d and et al. Mortality of patients was associated with 12 risk factors:diabetic history, septic shock, APACHE score ≥ 20 points, SOFA score ≥ 2 points, blood sugar ≥ 8.3 mmol/L, duration of operation ≥ 3 h, more than three catheterizations, more than 2 kinds of bacterial infection, duration of infection< 5 d, hospital stay < 20 d and et al. Septic shock, APACHE score ≥ 20 points, SOFA score ≥ 2 points, more than three catheterizations, more than 2 kinds of bacterial infection were the common risk factors of nosocomial infection and death of patients with sepsis. The patients with the above 5 factors should be transferred to the ICU for intensive treatment. Conclusion The patients with 5 common risk factors (Septic shock, APACHE score ≥ 20 points, SOFA score ≥ 2 points, more than three catheterizations, more than 2 kinds of bacterial infection) should be paid more attentions on their treatment to improve the prognosis. If APACHE score ≥ 20 points and SOFA score ≥ 2 points, anti-infective therapy should be performed immediately, and start the standard process for the treatment of sepsis. Most of sepsis patients died less than 5 days after infection, the early diagnosis and treatment is very important for the prognosis of sepsis.
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Key words:
- Sepsis /
- Nosocomial infection /
- Death /
- Risk factors
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