脓毒症患者引发急性肺损伤危险因素分析

苏彩燕　　赵伟丽　　王美娇　　林荣海

[关键词] 脓毒症;急性肺损伤;危险因素;急性呼吸窘迫综合征;多器官功能衰竭

[中图分类号] R459.7          [文献标识码] B          [文章编号] 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

脓毒症为重症监护室患者常见危重症之一，为机体受到感染、创伤及手术后常见并发症，临床表现为全身严重炎症反应，可对各个脏器造成损伤，其中急性肺损伤（Acute lung injury，ALI）为脓毒症常见且严重并發症[1]。有研究指出，脓毒症导致 ALI 发病率高达25%～45%，脓毒症合并ALI 患者临床死亡率高达 50%～60%[2]，严重影响患者的预后。尽管这几年来医学有了进一步的发展，但严重脓毒症导致的急性肺损伤和急性呼吸窘迫综合征（Acute respiratory distress syndrome，ARDS）仍居高不下。明确危险因素对脓毒症合并ALI患者的诊治及预后有重要意义，因此本研究探讨脓毒症患者发生急性肺损伤的危险因素及预后，现报道如下。