尿液分析及胸部X线筛查重度感染或者脓毒性休克感染源的回顾性分析

目的：评估重症监护室的重症感染或者脓毒性休克患者尿常规检查和胸部X线检查的准确性。方法：回顾性分析我院进入重症监护室的确诊为重症感染或者脓毒性休克的患者，收集所有入组患者的个人情况，进入监护室以后的尿液检查结果、胸部X线检查结果，以及体液细菌学培养的结果，分析上述数据与诊断泌尿系感染或者肺部感染之间关系。结果：我们回顾了400例患者，其中70例患者确诊为重症感染或者脓毒性休克，其中13例患者确诊为泌尿系感染（尿常规，白细胞〉10／高倍镜视野），敏感性和特异性分别为81％（95％CI0．67-0．92）和65％（95％CI0．51—0．75）；36例患者确诊为肺部感染，胸部X线检查诊断肺部感染的的敏感性和特畀性分别为57％（95％C10．45—0．69）和92％（95％C10．82-0．93）。结论：对于脓毒血症或者脓毒性休克的患者，胸部X线检查敏感性较低，这可能与肺部X线检查干扰因素较多，并且肺部感染发生到出现影像学变化有一定的时间间隔：而尿液分析敏感性较高，但是也可能由于尿液中上皮细胞的存在而干扰诊断。

Microscopic Urine Analysis and Chest Radiography in Patients with Severe Sepsis and Septic Shock

Objective： The purpose of this study is to evaluate the accuracy of two diagnostic studies used in the emergency department （ED） to guide diagnosis of source of infection in this patient population. Methods： This was a retrospective review of ED patients admitted to an intensive care unit with the diagnosis of severe sepsis or septic shock over a period. We evaluated accuracy of initial microscopic urine analysis testing and chest radiography in the diagnosis of urinary tract infections and pneumonia, respectively, Results： Of the 400 patients admitted to intensive care units, 70 patients met criteria for severe sepsis and septic shock. There were a total of 13 patients diagnosed with urinary tract infection, and their initial microscopic urine analysis with counts 〉 10 white blood ceils were sensi- tive 81%（95% CI 0.67-0.92） and specific 65%（95% CI 0.51-0.75）,for the positive fmal urine culture result. There were 36 patients with final diagnosis of pneumonia. The sensitivity and specificity of initial chest radiography were, respectively, 57% （95% CI 0.45-0,69） and 92% （95% CI 0.82-0.93） for the diagnosis of pneumonia. Conclusion： In patients with severe sepsis and septic shock, the chest radiograph and urine analysishas low sensitivity.