Page 50 - 南京医科大学自然版

南京医科大学学报（自然科学版） 第44卷第7期
·934 · Journal of Nanjing Medical University（Natural Sciences） 2024年7月

·临床研究·

细菌性肝脓肿合并糖尿病患者出现脓毒性休克的危险因素分析

徐 杰 ，王 喆 ，张忠满 ，董艳彬 1*
1
1，2
1
南京医科大学第一附属医院急诊医学科，江苏 南京 210029；蚌埠医科大学第一附属医院重症医学科，安徽 蚌埠
1 2
233000

［摘 要］ 目的：通过分析细菌性肝脓肿合并糖尿病患者脓毒性休克的临床特征，探究预测休克的早期危险因素。方法：收集
南京医科大学第一附属医院2017年1月—2021年4月经CT引导下穿刺诊断为肝脓肿的240例糖尿病患者的临床资料，依据住
院期间是否出现脓毒性休克分为休克组及非休克组。纳入患者初诊时一般资料、首诊症状、生命体征、腹部CT及血生化指标
等，对休克的危险因素进行综合分析。结果：①休克组与非休克组一般资料比较，休克组年龄更大，差异有统计学意义（P < 0.05）。
②休克组患者呼吸频率、心率及最高体温均较非休克组患者显著升高，差异有统计学意义（P < 0.05），两组平均动脉压及脓肿
的CT表现差异无统计学意义（P > 0.05）。③休克组白细胞计数及中性粒细胞计数较非休克组显著增加，血小板计数显著减少。
④休克组凝血酶原时间、活化部分凝血活酶时间、凝血酶时间均较非休克组显著延长（P < 0.05），凝血酶原时间国际化标准化比值
增高（P < 0.05）。⑤经二元Logistic回归分析显示呼吸频率、最高体温及凝血酶原时间是脓毒性休克的独立预测因素。结论：初诊
时患者呼吸频率、最高体温及凝血酶原时间可为细菌性肝脓肿合并糖尿病患者休克的早期识别提供重要预测价值。
［关键词］ 肝脓肿；糖尿病；休克；危险因素
［中图分类号］ R575.4；R587.1 ［文献标志码］ A ［文章编号］ 1007⁃4368（2024）07⁃934⁃07
doi：10.7655/NYDXBNSN230987

Analysis of risk factors for septic shock in patients of pyogenic liver abscess complicated
with diabetes

1
1，2
1
XU Jie ，WANG Zhe ，ZHANG Zhongman ，DONG Yanbin 1*
Emergency Department，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029；Department of
1 2
Critical Care Medicine，the First Affiliated Hospital of Bengbu Medical University，Bengbu 233000，China
［Abstract］ Objective：By analyzing the clinical characteristics of septic shock in patients of pyogenic liver abscess complicated with
diabetes，we explored the early risk factors for shock prediction. Methods：We collected the clinical data of 240 diabetic patients with
liver abscesses assessed by computerized tomography（CT）in the First Affiliated Hospital of Nanjing Medical University from January
2017 to April 2021. According to whether septic shock occurred or not during hospitalization，these patients were divided into a shock
group and a non⁃shock group. The general information of patients at the first visit，symptoms，basic vital signs，abdominal CT and blood
biochemical indicators，etc. were analyzed to identify the risk factors of shock. Results：①Comparing the general data of two groups，
there was a significant difference in age（P < 0.05）. ②There were significant differences in respiratory rate，heart rate and maximum
body temperature between the two groups of patients（P < 0.05），and the differences in mean arterial pressure and CT manifestations of
absess were not statistically significant between two groups（P > 0.05）. ③Compared with the non⁃shock group，the white blood cell
count and neutrophil count in the shock group were significantly increased，but the platelet count was significantly decreased. ④The
prothrombin time，international standardized ratio of prothrombin time，partial thromboplastin activation time，and thrombin time were
significantly prolonged in the shock group compared with the non⁃shock group（P < 0.05）. ⑤The binary logistic regression analysis
showed that respiratory rate，maximum body temperature and prothrombin time were independent predictors of septic shock.
Conclusion：The respiratory rate，maximum body temperature and prothrombin time of patients at the first diagnosis may provide
important predictive value for the early identification of shock in patients with pyogenic liver abscess complicated with diabetes.

［基金项目］ 江苏省卫生健康委员会专科能力建设项目［苏财社（2021）79号］
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通信作者（Corresponding author），E⁃mail：dybbin@163.com