Page 128 - 北京京煤集团总医院第十届·2022学术年会论文集

北京京煤集团总医院 第十届·2022 学术年会论文集

age of (75.19±4.27) years old，APACHEⅡ score of (25.26±5.15) points，SOFA score of [9(7，

12)] points，CONUT score of [4(3，6)] points，incidence of acute kidney injury (AKI) of 58.0%，

incidence of septic shock of 55.0%，rate of tracheal intubation of 45.0%，and LAC at 24 h after

admission of [2.22(1.07，2.92)] mmol/L，which were higher than (72.89±4.47) years old，

(20.42±5.71) points，[8(5，10)] points，[3(2，4)] points，37.1%，33.6%，30.0%，and [1.75(0.87，
2.65)] mmol/L of the survival patients，and the differences were statistically significant (P<0.05).

The indicators with P<0.05 in the univariate analysis were introduced into the Logistics regression

model，and variables were screened using the Forward: LR method. After excluding the influence

of confounding factors，multivariate analysis showed that age，APACHEⅡ score，SOFA score，

CONUT score，and AKI were all risk factors for death at 28 d in patients with sepsis (P<0.05).

Conclusion：In addition to APACHEⅡ score，age，SOFA score，and incidence of AKI，which

predict the prognosis of elderly patients admitted with sepsis，the CONUT score is also a practical

indicator predicting the prognosis of elderly sepsis，and the negative impact of malnutrition on the

prognosis of patients with sepsis may include various factors such as immune alterations and

inflammatory pathways.

Key words Sepsis; Control of nutritional status; Malnutrition; Elderly patients; Short-term
prognosis

脓毒症诊治一直是临床医生面临的重大难题，有研究估计全球 20%的死亡率由脓毒症
[1]
导致 。老年人是脓毒症的高发人群，据文献报道，老年脓毒症患者的死亡率较高，约为
[2]
50%~60% 。老年患者因全身退行性改变及各脏器功能下降，当出现脓毒症后，大量分解代
谢，可能会导致或加剧潜在的营养不良，营养不良可能是反映脓毒症住院患者疾病严重程度

的一个标志，能够更好的协助临床医生进行风险分层，做出正确的临床决策。本研究回顾性

分析急诊重症监护病房老年脓毒症患者的临床资料，对众多可能影响患者预后的因素进行分

析，初步探讨老年脓毒症患者入院 CONUT 评分与短期预后的关系，以期提高早期预警，从

而进行早期干预、个体化诊疗，降低病死率。

1 资料与方法

1.1 一般资料 回顾性分析 2018 年 9 月~2021 年 4 月北京京煤集团总医院急诊 ICU 收治的

240 例老年脓毒症患者的临床资料。纳入标准：①符合脓毒症 3.0 诊断标准；②年龄>65 岁。

排除标准：①急诊 ICU 住院时间≤24 h；②合并血液系统疾病、肿瘤终末期、严重肝肾功能

不全、近期使用抗凝药物治疗、明显的免疫功能抑制者；③病历资料不全或失去随访。本研

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