| 乔 允,陆晓晔,徐欣晖,刘 黎,杨 倩,朱长清.急诊科尿源性脓毒症的临床回顾性研究[J].,2019,19(2):253-257 |
| 急诊科尿源性脓毒症的临床回顾性研究 |
| A Retrospective Study on the Urosepsis in the Emergency Department |
| 投稿时间：2018-03-23 修订日期：2018-04-18 |
| DOI：10.13241/j.cnki.pmb.2019.02.011 |
| 中文关键词: 尿路感染 尿脓毒症 回顾性研究 器官功能障碍 |
| 英文关键词: Urinary tract infection Urosepsis Retrospective study Organ dysfunction |
| 基金项目:上海市科学技术委员会科研计划项目(15DZ1941307) |
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| 中文摘要: |
| 摘要 目的：回顾性研究急诊科住院患者的尿路感染及其所致脓毒症的临床及病原学特征。方法：选取2014年1月至2017年8月上海交通大学医学院附属仁济医院急诊病房及急诊ICU收治住院的106名诊断为“尿路感染”的患者，结合出院诊断及新版脓毒症诊断标准再评估，分为“尿脓毒症组”(n=45)和“非脓毒症组”(n=61)，收集和比较一般临床资料、实验室指标、病原学分类及特征。结果：1)尿脓毒症组上尿路感染、泌尿系统梗阻以及上尿路梗阻并感染的发生率均显著高于非脓毒症组(P=0.042，P=0.011，P=0.035)。2)尿脓毒症组白细胞计数(P=0.002)、C反应蛋白(P<0.001)、降钙素原(P=0.028)、肌酐(P<0.001)、D-二聚体(P<0.001)、APACHE II评分(Acute Physiology and Chronic Health Evaluation II，APACHE II)(P<0.001)均明显高于非脓毒症组，而血清白蛋白(P<0.001)、血小板(P<0.001)计数、Glasgow评分(P<0.001)均显著低于非脓毒症组；3)尿脓毒症组急性肾脏功能障碍(28/45，62.22%)发生率最高，凝血系统功能障碍发生率次之(25/45，55.56%)。中段尿培养中以屎肠球菌占比最高(11/40，27.5%)，其次为大肠埃希菌(8/40，20%)。结论：上尿路感染与泌尿系统梗阻是发生尿脓毒症的危险因素，相较于非脓毒症患者，尿脓毒症患者炎症指标、肌酐、D-二聚体、APACHE II评分水平更高，白蛋白、血小板及Glasgow评分更低，肾功能障碍与凝血功能障碍在尿脓毒症患者中更多见。临床需对中段尿培养肠球菌阳性的患者引起重视。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the clinical and laboratory characteristics of patients diagnosed with urinary tract infection(UTI) and urosepsis who were admitted in the Emergency Department. Methods: Patients who were admitted in the Emergency Ward and Emergency Intensive Care Unit (EICU) of Ren Ji hospital affiliated to School of Medicine, Shanghai Jiao Tong University (Shanghai, China) due to urinary infection from January 2014 to August 2017 were retrospectively studied, they were divided into two groups: urosepsis group(n=45) and non-sepsis group(n=61) according to the final discharge diagnosis and Sepsis 3.0. The data of clinical features, laboratory biomarkers, and pathogenic characteristics were collected and analyzed. Results: 1)The incidence of upper urinary infection, urinary tract obstruction and Infection occurring in upper urinary tract obstruction were significantly higher in urosepsis group than those in the non-sepsis group(P=0.042, P=0.011, P=0.035). 2)Compared with non-sepsis group, the urosepsis group had significantly higher laboratory parameters including peripheral leukocyte count(P=0.002), serum C-reactive protein (P<0.001), plasma calcitonin (P=0.028), serum creatinine(P<0.001), and blood D-dimer(P<0.001) and APACHE II score(P<0.01). While significantly lower serum albumin (P<0.001), lower platelet count(P<0.001) and lower Glasgow score(P<0.01) were observed in urosepsis group. 3) Patients with urosepsis were more likely to develop acute kidney injury(28/45, 62.22%), followed by dysfunction of blood coagulation system(25/45, 55.56%). Ente- rococcus faecium was the leading causative bacteria in midstream urine culture(11/40, 27.5%), followed by Escherichia coli (8/40, 20%). Conclusion: Upper urinary tract infection and urinary tract obstruction were risk factors for the occurrence of urosepsis. Urosepsis pa- tients had significantly higher inflammatory biomarkers, higher creatinine, higher D-dimer level, higher APACHE II score, lower albu- min, lower platelet count and lower Glasgow score. Kidney function and blood coagulation function were affected more by urosepsis. More attention were needed to the increase detection rate of Enterococcus in urine culture. |
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