Page 103 - 南京医科大学自然版

第45卷第7期 南京医科大学学报（自然科学版）
2025年7月 Journal of Nanjing Medical University（Natural Sciences） ·1001 ·

·临床研究·

革兰阴性杆菌血流感染的脓毒症相关性脑病患者临床特征分析

李天时，朱 轶，张忠满，陈家慧，尤晓冬，李 伟，陈旭锋，黄培培 *
南京医科大学第一附属医院急诊医学科，江苏 南京 210029

［摘 要］ 目的：通过回顾分析革兰阴性（Gram negative，G ）杆菌血流感染患者数据，总结该类患者脓毒症相关性脑病（sepsis
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associated encephalopathy，SAE）发生率及临床转归。方法：回顾 2021 年 1 月—2024 年 6 月于南京医科大学第一附属医院急诊
医学中心就诊的发热患者资料。将急诊就诊后首次血培养G 杆菌阳性并符合脓毒症诊断的患者纳入研究，依据病程中是否
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发生SAE将患者分为SAE组和无SAE组，采用倾向评分匹配（propensity score matching，PSM）调整SAE组和无SAE组间的混杂
因素后绘制两组患者 30 d Kaplan⁃Meier（K⁃M）生存曲线。结果：207 例患者被纳入研究，其中 92 例（44.4%）发生 SAE，SAE 组
30 d生存率低于无SAE组（69.6% vs. 97.4%，P < 0.001）。采用PSM法匹配SAE组和无SAE组基线资料后，SAE组患者的30 d存活率
更低（72.3% vs. 100.0%，P < 0.001），重症监护室（Intensive Care Unit，ICU）时长更长［5（0，11）d vs. 0（0，5）d，P < 0.001］，有创机
械通气比例（40.0% vs. 1.5%，P < 0.001）、连续肾脏替代治疗比例（32.3% vs. 4.6%，P < 0.001）、使用血管活性药物比例（50.8% vs.
15.4%，P < 0.001）更高，K⁃M曲线示SAE组患者30 d生存状态显著差于无SAE组（HR=8.730，95%CI：3.443~22.140，P < 0.001）。
结论：SAE是G 杆菌血流感染的脓毒症患者常见并发症，并会导致不良预后。
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［关键词］ 脓毒症；脓毒症相关性脑病；血流感染；革兰阴性杆菌；倾向评分匹配
［中图分类号］ R459.7；R747.9 ［文献标志码］ A ［文章编号］ 1007⁃4368（2025）07⁃1001⁃07
doi：10.7655/NYDXBNSN241469

Clinical characteristics analysis of patients with sepsis⁃associated encephalopathy caused
by Gram⁃negative bacilli bloodstream infection

LI Tianshi，ZHU Yi，ZHANG Zhongman，CHEN Jiahui，YOU Xiaodong，LI Wei，CHEN Xufeng，HUANG Peipei *
Department of Emergency Medicine，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，
China

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［Abstract］ Objective：This study retrospectively analyzed data from patients with Gram⁃negative（G ）bacilli bloodstream infections
to summarize the incidence and clinical outcomes of sepsis⁃associated encephalopathy（SAE）in these patients. Methods：The data of
febrile patients treated in the Emergency Medicine Center of the First Affiliated Hospital of Nanjing Medical University from January
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2021 to June 2024 were reviewed. Patients with G bacilli⁃positive blood cultures at initial emergency presentation meeting sepsis
diagnostic criteria were enrolled. Based on SAE development during the disease course ，patients were categorized into SAE and
non⁃SAE groups. Propensity score matching（PSM）was used to adjust for confounding factors between groups，followed by 30⁃day
Kaplan⁃Meier（K⁃M）survival curves analysis. Results：A total of 207 patients were included in the study，with 92（44.4%）developing
SAE. The 30⁃day survival rate was lower in the SAE group than in the non⁃SAE group（69.6% vs. 97.4%，P < 0.001）. After PSM
adjustment for baseline characteristics，the SAE group exhibited worse outcomes：lower the 30⁃day survival（72.3% vs. 100.0%，P < 0.001），
longer ICU stays［5（0，11）d vs. 0（0，5）d，P < 0.001］，higher rates of invasive mechanical ventilation（MV）（40.0% vs. 1.5%，P < 0.001），
continuous renal replacement therapy（CRRT）（32.3% vs. 4.6%，P < 0.001），and use of vasoactive drugs（50.8% vs. 15.4%，P < 0.001）.
The K⁃M curve demonstrated significantly poorer 30⁃day survival in the SAE group（HR=8.730，95% CI：3.443-22.140，P < 0.001）.
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Conclusion：SAE is a common complication in septic patients with G bacilli bloodstream infections and leads to poor prognosis.
［Key words］ sepsis；sepsis⁃associated encephalopathy；bloodstream infection；Gram⁃negative bacilli；propensity score matching
［J Nanjing Med Univ，2025，45（07）：1001⁃1006，1034］

［基金项目］ 江苏省科教能力提升工程-江苏省医学重点学科（ZDXK202213）
通信作者（Corresponding author），E⁃mail：hppcz1980@njmu.edu.cn（ORCID：0000⁃0002⁃9275⁃8112）
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