2021 年第 7 期 第 16 卷

脓毒症患者血液净化治疗28天预后的影响因素分析

Infuencing factors of 28 days prognosis in patients with sepsis undergoing blood purification

作者：赵春莉曹昌萌柳颖李纯董志扬刘菲

英文作者：Zhao Chunli Cao Changmeng Liu Ying Li Chun Dong Zhiyang Liu Fei

单位：辽宁省大连市友谊医院重症医学科116001

英文单位：Department of Intensive Care Unit Dalian (Municipal) Friendship Hospital Liaoning Province Dalian 116001 China

关键词：脓毒症；血液净化；预后

英文关键词：Sepsis;Bloodpurification;Prognosis

• 摘要：

• 目的 探讨脓毒症患者血液净化治疗28 d预后的影响因素。方法 选取辽宁省大连市友谊医院2018年11月至2020年11月收治的行血液滤过治疗的脓毒症患者92例，根据其28 d预后情况分为生存组（73例）和死亡组（19例）。比较2组患者的一般临床资料，应用Logistic回归分析法对患者血液滤过治疗28 d生存的影响因素进行分析。结果 生存组急性生理学与慢性健康状况评分系统Ⅱ评分，机械通气、脓毒症休克、器官衰竭数≥2个、2型糖尿病比例，血清降钙素原和血乳酸水平均低于死亡组，重症监护病房住院时间短于死亡组［（12±6）d比（15±6）d］，改善全球肾脏病预后组织急性肾损伤分期Ⅰ期、应用脉冲式高容量血液滤过比例和血清白蛋白水平均高于死亡组［35.6%（26/73）比10.5%（2/19），69.9%（51/73）比42.1%（8/19），（35±9）g/L比（26±7）g/L］（均P＜0.05）。多因素Logistic回归分析结果显示，急性生理学与慢性健康状况评分系统Ⅱ评分≥20分、机械通气、脓毒症休克、2型糖尿病、器官衰竭数≥2个、重症监护病房住院时间≥14 d、降钙素原≥10 μg/L、血乳酸≥8 μmol/L均为脓毒症患者血液滤过治疗28 d预后的危险因素(比值比=2.154、1.783、2.455、1.265、1.497、1.573、1.489、1.065，均P＜0.05)，改善全球肾脏病预后组织急性肾损伤分期Ⅰ期、采用脉冲式高容量血液滤过和血清白蛋白≥30 g/L均为保护因素(比值比=0.737、0.932、0.988，均P＜0.05）。结论 影响脓毒症患者血液净化治疗28 d预后的因素较多，临床治疗应有针对性地采取对症治疗措施，以消除危险因素，降低病死率，提高疗效。

• Objective To explore the influencing factors of 28 d prognosis in patients with sepsis undergoing blood purification. Methods From November 2018 to November 2020, 92 patients with sepsis who underwent hemofiltration treatment in Dalian (Municipal) Friendship Hospital, Liaoning Province were enrolled. Patients were divided into survival group (73 cases) and death group (19 cases) according to their 28 d prognosis. The general clinical data of the two groups were compared, and the influencing factors of 28 d survival were analyzed by Logistic regression analysis. Results Acute physiology and chronic health evaluation scoring system Ⅱ(APACHE Ⅱ) score, rates of mechanical ventilation, septic shock, organ failure number≥2 and type 2 diabetes mellitus, serum procalcitonin level and blood lactate level in survival group were lower than those in death group, and the length of intensive care unit(ICU) stay in survival group was shorter than that in death group ［(12±6)d vs (15±6)d］, the rates of kidney disease improving global outcomes(KDIGO) acute kidney injury(AKI) stage Ⅰ and using pulse high volume hemofiltration, and serum albumin level in survival group were higher than those in death group ［35.6%(26/73) vs 10.5%(2/19), 69.9%(51/73) vs 42.1%(8/19), (35±9)g/L vs (26±7)g/L］ (all P＜0.05). Multivariate Logistic regression analysis showed that APACHE Ⅱ score≥20, mechanical ventilation, septic shock, type 2 diabetes mellitus, organ failure number≥2, length of ICU stay≥14 d, procalcitonin≥10 μg/L and blood lactate≥8 μmol/L were risk factors for 28 d prognosis in sepsis patients undergoing hemofiltration treatment(odds ratio=2.154, 1.783, 2.455, 1.265, 1.497, 1.573, 1.489, 1.065, all P＜0.05); KDIGO AKI stage Ⅰ, using pulse high volume hemofiltration and serum albumin≥30 g/L were protective factors (odds ratio=0.737,0.932,0.988, all P＜0.05). Conclusions There are many factors influencing the 28 d prognosis of blood purification in patients with sepsis. In order to eliminate the risk factors, reduce the fatality rate and improve the curative effect, targeted treatment measures should be taken in clinical treatment.