【摘要】 目的 从重度胡蜂螫伤患者临床早期易获取的各项指标及常用评分系统中筛选脓毒症的早期危险因素，构建脓毒症早期预测评分模型并提前干预。方法 回顾性分析2016年1月至2021年5月在西安交通大学医学部附属三二〇一医院重症医学科(ICU)住院时间超过72 h且符合纳入标准的109例重度胡蜂螫伤患者临床资料，以发生脓毒症作为预后观察指标，采用单因素Logistic回归分析筛选出差异有统计学意义的危险因素，进一步使用多因素Logistic回归分析评价筛选出的指标是否为重度胡蜂蛰伤患者并发脓毒症的早期独立危险因素，并采用最小加权法构建预测评分模型，运用受试者工作特征曲线(ROC)检测该预测评分模型的效能。结果 重度胡蜂螫伤患者并发脓毒症的单因素Logistic回归分析结果显示，影响因素有年龄、蜇伤数目、序贯器官衰竭评分(SOFA)、乳酸(Lac)、C反应蛋白(CRP)(P<0.05)。进一步行多因素Logistic回归分析显示，年龄(OR=1.107,95%CI:1.023～1.199,P=0.012)、蜇伤数目(OR=1.630,95%CI:1.018～1.175,P=0.006)的增加、CRP(OR=1.057,95%CI:1.022～1.093,P=0.001)是重度胡蜂螫伤患者并发脓毒症的独立危险因素。根据构建的早期预测评分模型，将脓毒症风险分为低危(0～2分)、中危(3～5分)、高危(>5分),三类重度胡蜂蛰伤患者的脓毒症发生率差异具有统计学意义(P<0.05)。ROC曲线分析结果显示，该预测评分模型对重度胡蜂螫伤患者并发脓毒症具有优秀的预测能力(AUC=0.954,95%CI:0.916～0.989)。结论 构建的预测评分模型对重度胡蜂蛰伤患者并发脓毒症具有早期预测及评估价值，在此基础上进行的危险分层有助于提前采取干预措施降低脓毒症的发生率。更多还原

【Abstract】 Objective This study aimed to screen the early risk factors for sepsis from the early clinically common test indexes and scoring systems of severe wasp sting patients, and then construct an early predictive scoring model of sepsis and used for early intervention. Methods The clinical data from 109 severe wasp sting patients who were admitted at the ICU of 3201 Hospital of Xian Jiaotong University Health Science Center for over 72 h between January 2016 and May 2021 and conformed to the inclusion criteria were retrospectively analyzed. The sepsis incidence was used as the prognosis observational index, Univariate logistic regression analysis was used to screen out risk factors with statistically significant differences, and multivariate logistic regression analysis was further used to evaluate whether the screened indicators were early independent risk factors for severe wasp sting complicated with sepsis.The predictive scoring model was constructed by the weighted least square method. The receiver operating characteristic curve was used to test the effectiveness of the predictive scoring model. Results The univariate regression analysis results of sepsis suggested that the influencing factors were age, number of stings, sequential organ failure assessment, lactate and C-reactive protein(CRP)(P<0.05). Further multivariate logistic regression analysis indicated that, the age(OR=1.107,95%CI:1.023-1.199,P=0.012), number of stings(OR=1.630,95%CI:1.018-1.175,P=0.006)and CRP(OR=1.057,95%CI:1.022-1.093,P=0.001)were the independent risk factors for sepsis in severe wasp sting patients. According to the early predictive scoring model, risk of sepsis was divided into low risk(0-2), medium risk(3-5) and high risk(>5).The difference in the incidence of severe wasp sting complicated with sepsis among the three groups were statistically significant(P<0.05). The analysis result of ROC curve indicated that the predictive scoring model had excellent predictive ability for severe wasp sting complicated with sepsis(AUC=0.954,95%CI:0.916-0.989). Conclusion The predictive scoring model has the value of early prediction and evaluation of severe wasp sting complicated with sepsis. Based on the risk stratification, it is helpful to take intervention and reduce the incidence of sepsis.更多还原