Epidemiology of severe sepsis in critically ill surgical patients in ten university hospitals in China
Epidemiology of severe sepsis in critically ill surgical patients in ten university hospitals in China
复制标题
我国10所大学附属医院危重外科患者严重脓毒症流行病学调查
DOI：
10.1097/01.ccm.0000284492.30800.00
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发表时间：
2007-11-01
影响因子：
8.8
通讯作者：
Fang, XiangMing
中科院分区：
文献类型：
--
作者：
Cheng, Baoli;Xie, Guohao;Fang, XiangMing
目的：确定中国多个医疗中心外科重症监护病房严重脓毒症的发生率、结局和特征，并评估中国严重脓毒症的成本和资源使用情况。设计和设置：对中国六个省十所大学医院外科重症监护病房患者进行前瞻性观察研究。患者：2004年12月1日至2005年11月30日在研究的重症监护病房的所有成人入院。无。测量和主要结果。严重脓毒症的标准基于美国胸科医师学会/重症监护医学会共识会议的定义。对3，665例重症监护室入院的数据进行分析，确定了318例（8.68%）严重脓毒症病例，其中64.8%为男性。严重脓毒症患者的中位年龄（四分位距）为64（47-74）岁。228例（71.7%）患者分离出微生物，包括171例（53.8%）革兰氏阴性菌和146例（45.9%）革兰氏阳性菌。共有90例（22.0%）患者发生侵袭性真菌感染，其中20例（6.3%）为真菌血症。感染部位以腹部最多见（72.3%），其次为肺部（52.8%）。严重脓毒症的总住院死亡率为48.7%。住院死亡的危险因素包括年龄、恶性肿瘤的慢性合并症、革兰氏阳性细菌感染、侵袭性真菌感染、入院急性生理学评分和入院呼吸功能障碍和心血管功能障碍的序贯器官衰竭评估评分。中位治疗干预评分系统-28评分为43（38-49）。平均住院费用为$11，390/例，$502/例/day.Conclusions，严重脓毒症是一种常见的，昂贵的，经常致命的综合征，在中国的外科危重病人。除微生物学模式外，中国外科重症监护病房中严重脓毒症的发病率、死亡率和主要特征与发达国家的记录接近。
Objectives: To determine the occurrence rate, outcomes, and the characteristics of severe sepsis in surgical intensive care units in multiple medical centers within China and to assess the cost and resource use of severe sepsis in China.Design and Setting: Prospective, observational study of surgical intensive care unit patients at ten university hospitals in six provinces in China.Patients: All adult admissions in studied intensive care units from December 1, 2004, to November 30, 2005.Interventions. None.Measurements and Main Results. The criteria of severe sepsis were based on the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definition. Analysis of data from 3,665 intensive care unit admissions identified 318 (8.68%) cases of severe sepsis, 64.8% of which were men. The median age (interquartile range) of patients with severe sepsis was 64 (47-74) yrs. Microbes had been isolated from 228 (71.7%) patients, including 171 (53.8%) with Gram-negative bacteria and 146 (45.9%) with Gram-positive bacteria. A total of 90 (22.0%) patients had invasive fungal infection, 20 (6.3%) of which had fungemia. The abdomen was the most common site of infections (72.3%), followed by lung (52.8%). The overall hospital mortality of severe sepsis was 48.7%. Risk factors for hospital mortality included age, chronic comorbidity of malignant neoplasm, Gram-positive bacterial infection, invasive fungal infection, admission Acute Physiology Score, and admission Sequential Organ Failure Assessment score of respiratory dysfunction and cardiovascular dysfunction. The median Therapeutic Intervention Scoring System-28 score was 43 (38-49). The mean hospital cost was $11,390 per patient and $502 per patient per day.Conclusions, Severe sepsis is a common, expensive, and frequently fatal syndrome in critically ill surgical patients in China. Other than the microbiological patterns, the incidence, mortality, and major characteristics of severe sepsis in Chinese surgical intensive care units are close to those documented in developed countries.