| 纪小奇,崔 静,李 萌,赵晶晶,姚 莉.复杂性腹腔感染的病原菌分布及APACHEⅡ评分、SOFA评分联合PCT检测的预后评估价值研究[J].,2021,(11):2138-2142 |
| 复杂性腹腔感染的病原菌分布及APACHEⅡ评分、SOFA评分联合PCT检测的预后评估价值研究 |
| Distribution of Pathogens in Complicated Abdominal Infection and Prognostic Evaluation Value of APACHEⅡ Score, SOFA Score Combined with PCT Detection |
| 投稿时间：2020-12-06 修订日期：2020-12-28 |
| DOI：10.13241/j.cnki.pmb.2021.11.031 |
| 中文关键词: 复杂性腹腔感染 病原菌 APACHEⅡ评分 SOFA评分 PCT 预后 |
| 英文关键词: Complex abdominal infection Pathogen distribution APACHE II score SOFA score PCT Prognosis |
| 基金项目:安徽省科技厅公益联动项目基金（1501ld04060） |
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| 中文摘要: |
| 摘要 目的：探讨复杂性腹腔感染的病原菌分布及急性生理和慢性健康状况Ⅱ（APACHEⅡ）评分、序贯器官衰竭（SOFA）评分联合降钙素原（PCT）检测的预后评估价值。方法：选择合肥市第二人民医院2016年1月至2020年10月收治的80例复杂性腹腔感染患者，分析腹腔细菌的病原菌分布情况。根据患者预后情况分为生存组（n=45）、死亡组（n=35），比较两组APACHEⅡ评分、SOFA评分、PCT、C反应蛋白（CRP）、白细胞计数（WBC）、中性粒细胞比例、血乳酸水平。分析患者预后的影响因素，并应用受试者工作特征（ROC）曲线分析APACHEⅡ评分、SOFA评分、PCT及三者联合检测对预后的预测价值。结果：80例复杂性腹腔感染患者共培养出病原菌112株，其中革兰氏阳性球菌20株（占比17.86%），革兰氏阴性杆菌64株（占比57.14%），真菌28株（占比25.00%）。死亡组白色念珠菌、铜绿假单胞菌感染比例显著高于存活组，大肠杆菌感染比例显著低于存活组（P<0.05），死亡组血清APACHEⅡ评分、SOFA评分、PCT、CRP、血乳酸水平显著高于存活组，WBC、中性粒细胞比例显著低于存活组（P<0.05）。多因素Logistic回归分析显示，铜绿假单胞菌感染、白色念珠菌感染、APACHEⅡ评分≥20分、SOFA评分≥14分、PCT≥7.00 ng/mL、CRP≥100.00 mg/L、血乳酸≥4 mmol/L、WBC<6.00×109、中性粒细胞比例<80.00%是患者死亡的危险因素（P<0.05）。ROC曲线分析显示APACHEⅡ评分、SOFA评分联合PCT检测对患者预后评估的敏感度为95.93%，特异度为92.38%。结论：复杂性腹腔感染以革兰氏阴性杆菌为主，其死亡危险因素较多，联合检测APACHEⅡ评分、SOFA评分及PCT评估预后价值较高。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the distribution of pathogens in complicated abdominal infection and the prognostic evaluation value of acute physiology and chronic health II (APACHE II) score, sepsis related organ dysfunction (SOFA) score combined with procalcitonin (PCT) detection. Methods: 80 patients with complicated abdominal infection in Hefei Second People's Hospital from January 2016 to October 2020 were selected, the distribution of pathogenic bacteria in abdominal cavity were analyzed. According to the prognosis, the patients were divided into survival group (n=45) and death group (n=35). The APACHE II score, SOFA score, PCT, C-reactive protein (CRP), white blood cell count (WBC), neutrophil ratio and blood lactic acid levels were compared between the two groups. The influence factors of the prognosis of patients were analyzed, and apply the receiver-operating characteristic (ROC) curve analysis APACHE Ⅱ score, SOFA score, PCT and the value of combined detection of prognosis prediction. Results: A total of 112 strains of pathogens were isolated from 80 patients with complex abdominal infection, including 20 strains of gram-positive cocci (account for 17.86%), 64 strains of gram-negative bacilli (account for 57.14%) and 28 strains of fungi (account for 25.00%). The infection rate of Candida albicans and Pseudomonas aeruginosa in the death group were significantly higher than those in the survival group, and the infection rate of Escherichia coli was significantly lower than that in the survival group (P<0.05). The serum APACHE II score, SOFA score, PCT, CRP and blood lactic acid levels in the death group were significantly higher than those in the survival group, and the ratio of WBC and neutrophils were significantly lower than those in the survival group (P<0.05). Multivariate logistic regression analysis showed that Pseudomonas aeruginosa infection, Candida albicans infection, APACHE II score is greater than or equal to 20 scores, SOFA score is greater than or equal to 14 scores, PCT is greater than or equal to 7.00 ng/mL, CRP is greater than or equal to 100.00 mg/L, blood lactic acid is greater than or equal to 4 mmol/L, WBC is less than 6.00×109, neutrophil ratio is less than 80.00% were the risk factors for patients death (P<0.05). ROC curve analysis showed that the sensitivity and specificity of APACHE II score, SOFA score combined with PCT were 95.93% and 92.38%, respectively. Conclusion: Complicated abdominal infection is given priority to with gram-negative bacilli, they have more risk factors for death, more combined with detection APACHE Ⅱ score, SOFA score and prognosis of PCT evaluation value is higher. |
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