关键词:

腹部术后, 脓毒症, 脓毒性休克, 血红蛋白, 碳酸氢根, 风险因素, 联合预测

Abstract:

Objective To explore the risk factors and reliable evaluation indicators that affect the death of patients with sepsis after abdominal surgery，and to establish a predictive model in intensive care unit（ICU） Methods This is a retrospective case⁃control study ，analyzing the clinical data of patients with sepsis after abdominal surgery admitted to the Department of Intensive Care Medicine，Affiliated Hospital of Guizhou Medical University from January 2018 to December 2020. The information of sex，age，body mass index，heart rate，and mean arterial pressure when transferred to the ICU，the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHEⅡ）score and the Sequential Organ Failure Assessment（SOFA）score for the first 24 hours of entering the ICU，and data of blood routine，biochemistry，arterial blood gas analysis，procalcitonin，surgical site，opera⁃ tion time，ICU length of stay，mechanical ventilation time，and total length of stay were collected and analyzed for the correlation of prognostic factors. Conditional forward method and multivariate logistic regression analysis were adopted to automatically screen the independent variables when the best balance between the fitting degree of the prediction model and the number of independent variables was achieved then the predictive model was established. Results From January 2018 to December 2020，a total of 256 patients with sepsis after abdominal surgery met the inclusion criteria. Among them，there were 160 males and 96 females，with an average age of 64（19，93）years. There were 199 cases in the survival group and 57 cases in the non⁃survival group. The mortality was 22.3%. Univariate analysis showed that heart rate，lactic acid，creatinine，procalcitonin，APACHEⅡ score and SOFA score within 24 hours in the non survival group were significantly higher than those in the survival group，while hemoglobin，bicarbonate and platelet were lower. The mortality of patients with septic shock and hypertension were higher. Multivariate logistic regression found that high APACHEⅡ score（OR = 1.088；95%CI：1.007 ~ 1.175； P = 0.033），tachycardia（OR = 1.02；95%CI：1.005 ~ 1.035；P = 0.007）and combined shock（OR = 5.672； 95%CI：2.204 ~ 1 5.898；P = 0.001）were risk factors for death in these patients，while high hemoglobin（OR = 0.984；95%CI：0.970 ~ 0.998；P = 0.024），and high bicarbonate（OR = 0.85；95%CI：0.764 ~ 0.945；P = 0.003） were protective factors. The maximum area under curve predicted by joint variables was 85.6% ；the sensitivity 0.856，and the specificity 72.4%. The predictive value was better than that of above⁃mentioned five single variables. Conclusion APACHEⅡ score ，heart rate ，septic shock ，hemoglobin and bicarbonate are the key factors affecting the death of patients with sepsis after abdominal surgery. The accuracy of combined variables in pre⁃ dicting the prognosis of abdominal postoperative sepsis is higher than that of single variables，and the diagnostic value is higher.

Key words:

abdominal surgery, sepsis, septic shock, hemoglobin, bicarbonate, risk factors, joint prediction