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普通外科手术后合并腹腔感染患者入住ICU的预后危险因素
张小玲,王志东,侯彦丽,赵玉杰,郭蕾,骆艳妮,王小闯
0
(西安交通大学第二附属医院重症医学科;西安交通大学第二附属医院普通外科四病区)
摘要:
【摘要】目的 探讨普通外科术后合并腹腔感染患者入住重症监护病房(ICU)的病情及预后评估指标,为判断患者的严重程度和预后提供依据。方法 回顾性分析我院2014年6月~2017年6月普通外科术后并发腹腔感染需要入住ICU的70例患者临床资料,根据转出ICU结局分为生存组(n=46)和死亡组(n=24)。记录两组患者一般资料,包括性别、年龄、手术部位、住ICU时长;入科2 h内动脉血气血乳酸值(Lac)、内静脉血降钙素原(PCT)、血常规、血肌酐(Cre)、白细胞分类计数、中性粒细胞与淋巴细胞比值(NLR)及血小板(PLT)与淋巴细胞比值(PLR);入科24 h内病情最严重时进行急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)及SOFA评分。分析入住ICU腹腔感染患者病情及预后与各指标的关系。结果 两组患者年龄、性别构成、NLR、PLT、Lac及Cre比较差异无统计学意义(P>005)。与生存组相比,死亡组肠漏明显升高、入住ICU时间明显延长、PLR、PCT、APACHE Ⅱ及SOFA均显著升高(均P<005)。logistic回归分析结果表明,PLR、APACHE Ⅱ评分及SOFA评分是评估普通外科术后合并腹腔感染入住ICU患者预后的独立危险因素(P<005)。结论 APACHE Ⅱ评分、SOFA评分及PLR是判断普通外科术后合并腹腔感染患者疾病严重程度和预后的独立危险因素,可在一定程度上判断患者结局。
关键词:  普通外科术后  腹腔感染  重症监护病房  危险因素  评分
DOI:
基金项目:国家自然科学基金(81670049)
Evaluation indexes of postoperative infection status and prognosis in patients after general surgery
ZHANG Xiaoling,WAND Zhidong,HOU Yanli,ZHAO Yujie,GUO Lei,LUO Yanni,WANG Xiaochuang
(Department of Intensive Care Unit, The Second Affiliated Hospital of Xi’an Jiaotong University;The Fourth ward of Department of General Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University)
Abstract:
【Abstract】Objective To evaluate the status and prognosis of patients with abdominal infection admitted to intensive care unit (ICU) after general surgery and provide a basis for judging the severity and prognosis of patients. Methods The clinical data of 70 patients with abdominal infection after general surgery in our hospital from June 2014 to June 2017 were analyzed retrospectively. According to the outcome of transferring out of ICU, they were divided into survival group (n= 46) and death group (n=24). The general data of the two groups were recorded, including sex, age, operation site and length of stay in ICU; lac, PCT, blood routine, CRE, WBC count, NLR and PLR. 24 Acute physiology and chronic health status scoring system Ⅱ (APACHE Ⅱ) and sofa scores were performed when the disease was the most serious within H. The relationship between the condition and prognosis of patients with abdominal infection in ICU were recorded. Results There was no significant difference in age, sex composition, NLR, PLT, lac and cre between the two groups (P>005). Compared with the survival group, the leakage of intestines in the death group was significantly higher, the time of admission to ICU was significantly longer, PLR, PCT, Apache Ⅱ and sofa were significantly higher (P<005). Logistic regression analysis showed that PLR, Apache Ⅱ score and SOFA score were independent risk factors for the prognosis of patients with abdominal infection in ICU after general surgery (P<005). Conclusion pache Ⅱ score, SOFA score and PLR are independent risk factors to judge the disease severity and prognosis of patients with abdominal infection after general surgery, which can judge the outcome of patients to a certain extent.
Key words:  General surgery  Abdominal infection  Intensive care unit  Risk factors  Score

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