膿毒癥患者引發(fā)急性肺損傷危險因素分析

蘇彩燕　　趙偉麗　　王美嬌　　林榮海

[關(guān)鍵詞] 膿毒癥;急性肺損傷;危險因素;急性呼吸窘迫綜合征;多器官功能衰竭

[中圖分類號] R459.7? ? ? ? ? [文獻(xiàn)標(biāo)識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）20-0047-04

Analysis on risk factors of acute lung injury in patients with sepsis

SU Caiyan1? ?ZHAO Weili1? ?WANG Meijiao2? ?LIN Ronghai1

1.Department of Critical Care Medicine，Taizhou Hospital of Zhejiang Province，Linhai? ?317000，China;2.Medical Record Room，Taizhou Hospital of Zhejiang Province，Linhai? ?317000，China

[Abstract] Objective To explore the prognostic risk factors of acute lung injury induced by sepsis. Methods From January 2017 to December 2019，256 patients with sepsis who were admitted to our department were selected and divided into the sepsis-induced acute lung injury （ALI） group （n=89） and non-sepsis-induced ALI group （n=167）. General data， clinical data， infection sites， and infectious pathogens were statistically analyzed. The indicators were compared between the two groups， and the significant indicators （P<0.05） were selected for multivariate unconditional Logistic regression analysis. Results There was no statistically significant difference between the two groups in age， BMI， smoking， alcohol abuse， body temperature， blood pressure， respiration， and heart rate（P>0.05）; the indicators of sepsis-induced ALI group： underlying disease， oxygenation index， SOFA score， APACHE Ⅱ score，incidence rate of Acinetobacter baumannii and fungi， the incidence rate of lung and abdominal infections were significantly higher than those in non-sepsis-induced ALI group， and the differences were significant（P<0.05）; multivariate Logistic regression analysis showed that lung infection， SOFA score， APACHE Ⅱ score and oxygenation index were risk factors for sepsis complicated by acute lung injury（P<0.05）. Conclusion Pulmonary infection，SOFA score， APACHE Ⅱ score， and oxygenation index are risk factors for acute lung injury caused by sepsis，and clinical attention should be paid.

[Key words] Sepsis; Acute lung injury; Risk factors; Acute respiratory distress syndrome; Multiple organ failure

膿毒癥為重癥監(jiān)護(hù)室患者常見危重癥之一，為機(jī)體受到感染、創(chuàng)傷及手術(shù)后常見并發(fā)癥，臨床表現(xiàn)為全身嚴(yán)重炎癥反應(yīng)，可對各個臟器造成損傷，其中急性肺損傷（Acute lung injury，ALI）為膿毒癥常見且嚴(yán)重并發(fā)癥[1]。有研究指出，膿毒癥導(dǎo)致 ALI 發(fā)病率高達(dá)25%～45%，膿毒癥合并ALI 患者臨床死亡率高達(dá) 50%～60%[2]，嚴(yán)重影響患者的預(yù)后。盡管這幾年來醫(yī)學(xué)有了進(jìn)一步的發(fā)展，但嚴(yán)重膿毒癥導(dǎo)致的急性肺損傷和急性呼吸窘迫綜合征（Acute respiratory distress syndrome，ARDS）仍居高不下。明確危險因素對膿毒癥合并ALI患者的診治及預(yù)后有重要意義，因此本研究探討膿毒癥患者發(fā)生急性肺損傷的危險因素及預(yù)后，現(xiàn)報道如下。