【摘要】 目的探讨感染性休克的临床流行病学特点,为临床提高诊治水平提供参考依据。方法选择2010年1月1日-2013年2月28日收住的感染性休克患者98例为研究对象,采用回顾性分析方法对临床流行病学特点进行分析,根据结局分为存活组(63例)与死亡组(35例),对患者的年龄分布、发病季节、职业、地域分布、血常规、C-反应蛋白、血气分析、血白蛋白等进行对比分析,所有数据录入Excel表格进行处理,计数资料采用χ2检验。结果 98例感染性休克患者死亡35例,病死率35.71%;死亡组年龄>60岁患者占77.14%;感染性休克患者冬季发病率最高,占39.80%,与其他季度比较差异有统计学意义(P<0.01),死亡组患者则以夏冬季节明显,差异有统计学意义(P<0.05);基础疾病以肺、脑、胆道疾病最常见,死亡组患者则以结肠疾病、慢性肝病、骨折长期卧位患者较高;感染性休克以肺部感染最多见,差异有统计学意义(P<0.01),死亡组患者以腹膜炎、尿路感染较低;临床症状以发热、咳嗽、呕吐、心率>120/min等为主;死亡组患者白细胞明显下降、CRP明显增高,PaCO2明显下降或增高及血乳酸增高与病死率增高有关,临床各项指标两组比较差异均有统计学意义(P<0.01);检出病原菌以大肠埃希菌、肺炎克雷伯菌、肺炎链球菌、肠球菌属多见。结论感染性休克临床表现不典型、病情重、进展迅速,尤其是年老患者、寒冷和高温季节,白细胞、血小板、白蛋白明显下降,CRP、血乳酸明显增高者,病死率高。更多还原

【Abstract】 OBJECTIVE To explore the clinical epidemiologic characteristics of septic shock so as to provide guidance for the clinical diagnosis and treatment.METHODS A total of 98cases of septic shock,who were treated in the hospital from Jan 1,2010to Feb 28,2013,were enrolled in the study,then the clinical epidemiologic characteristics were retrospectively analyzed,the subjects were divided into the survival group(63cases)and the death group(35cases)according to the clinical outcomes,the age,onset season,occupation,regional distribution, blood routine,C-reactive protein,blood gas analysis,and albumin were observed and compared between the two groups,all the data were input to Excel spreadsheet for processing,and the chi-square test was conducted for count data.RESULTS Of the 98cases of septic shock,35cases died with the mortality rate of 35.71%;the patients aged more than 60years accounted for 77.14%in the death group;the incidence of septic shock was the highest(39.83%)in winter,as compared with other seasons,the difference was significant(P<0.01);in the death group,the septic shock was the most prevalent in summer and winter,the difference was significant(P< 0.05).The pulmonary disease,cerebral disease,and biliary tract disease were the most common underlying diseases;the mortality rate was relatively high in the septic shock patients with colorectal disease,chronic liver disease,or fracture of long-term recumbent;the pulmonary infection was the most common in the patients with septic shock,the difference was significant(P<0.01);among the death cases,the incidence of peritonitis or urinary tract infection was relatively low;the fever,cough,vomiting,and heart rate more than 120/min were the major clinical symptoms;in the death group,the significant decrease of white blood cells counts,significant elevation of CRP level,significant decrease or increase of PaCO2and elevation of blood lactate were related to the increase of mortality rate,the differences in the clinical indicators between the survival group and the death group were significant(P<0.01).Escherichia coli,Klebsiella pneumoniae,Streptococcus pneumoniae,and Enterococci were the most common species of pathogens isolated.CONCLUSION The clinical manifestations of the septic shock are atypical,with the illness condition severe,progression rapid;the mortality rate is relatively high in particular the elderly patients,cold or hot season,or the patients with significant decrease in white blood cells counts,platelets counts,or blood lactate.更多还原