老年患者术后脓毒血症预后影响因素分析

探讨发病原因及感染等因素对老年患者术后发生脓毒血症病情及预后的评估价值。

收集2019年1月—2021年11月外科重症监护室术后发生脓毒血症的老年患者92例，以生存结局分为死亡组和存活组，通过比较两组患者术前、术后身体质量指数（BMI）、血清总蛋白（TP）、白蛋白（Alb）、C−反应蛋白（CRP）、降钙素原（PCT）、B型利钠肽（BNP）、乳酸和D−二聚体（D-D）等指标差异，采用多因素logistic回归分析分析影响术后脓毒血症预后的危险因素，并绘制受试者工作特征曲线（ROC），计算ROC曲线下面积（AUC）。

两组老年患者合并的基础疾病中，消化系统疾病引发脓毒血症的死亡率高于其他系统疾病（P＜0.05）。存活组与死亡组术前血清TP、Alb、CRP、PCT、BNP、乳酸和D-D与术后比较差异无统计学意义（P＞0.05）。术后存活组与死亡组比较，血清乳酸、Alb、PCT、D-D和BNP差异均有统计学意义（P＞0.05）。多因素回归分析发现乳酸和BNP是影响术后脓毒血症死亡的危险因素，AUC分别为0.879和0.858。

血清乳酸和BNP与老年术后发生脓毒血症严重程度密切相关，对判断预后具有一定参考价值。老年患者术前的慢性病防治与消化系统疾病早发现、早期手术干预是老年患者规避重症感染的关键，对改善老年患者术后临床结局至关重要。

Prognostic factors of postoperative sepsis in elderly patients

ObjectiveTo explore the value of various indicators and disease factors in evaluating the condition and prognosis of sepsis in elderly patients after operation. MethodsA retrospective study was conducted in 92 elderly patients with sepsis after surgery in the surgical ICU from January 2019 to November 2021. According to the survival outcome, they were divided into the death group and the survival group. Preoperative and postoperative serum total protein (TP), albumin (Alb), C-reactive protein (CRP), procalcitonin (PCT), B-type natriuretic peptide (BNP), lactic acid and D-dimer (D-D) were compared between the two groups. Multivariate logistic regression analysis was used to analyze the risk factors affecting the prognosis of postoperative sepsis. Receiver operating characteristic (ROC) curve was plotted and the area under ROC curve (AUC) value was calculated. ResultsThe mortality of patients with digestive system diseases in both groups was higher than those with other system diseases (P＜0.05). There were no significant differences in serum TP, Alb, CRP, PCT, BNP, lactic acid and D-D between the two groups before surgery (P＞0.05), but in serum lactic acid, Alb, PCT, D-D and BNP after surgery (P＞0.05). Multifactor regression analysis showed that lactic acid and BNP were the risk factors for death of patients with postoperative sepsis, with AUCs of 0.879 and 0.858, respectively. ConclusionBlood lactic acid and BNP are closely related to the severity of postoperative sepsis in elderlies, which have certain reference value for the prognosis. Early detection of chronic diseases and mild digestive system diseases before surgery and early surgical intervention are the key to avoid severe infection in elderly patients, which is very important to improve the clinical outcome of elderly patients after surgery.