Kết quả điều trị và tiên lượng ở bệnh nhân nhiễm khuẩn nặng và sốc nhiễm khuẩn tại khoa Hồi sức Tích cực Bệnh viện Tâm Anh Hà Nội năm 2020 - 2024=Results of treatment and prognostic factors in patients with sepsis/septic shock at the intensive care unit of Tam Anh Hospital in Hanoi from 2020 to 2024

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Viết Ngọc Hà, Quang Tùng Phùng

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.178-186

Bộ sưu tập: Metadata

ID: 243887

Thêm vào giỏ

Đánh giá kết quả điều trị và phân tích một số yếu tố tiên lượng tử vong ở bệnh nhân nhiễm khuẩn nặng và sốc nhiễm khuẩn tại khoa Hồi sức tích cực (HSTC), Bệnh viện Tâm Anh Hà Nội. Đối tượng và phương pháp: Nghiên cứu mô tả cắt ngang tiến hành trên 48 bệnh nhân nhiễm khuẩn nặng hoặc sốc nhiễm khuẩn tại khoa HSTC, Bệnh viện Đa khoa Tâm Anh Hà Nội từ tháng 9/2020 tới tháng 3/2024. Kết quả điều trị được đánh giá dựa vào kết cục lâm sàng, thời gian thở máy, thời gian dùng vận mạch, số lần lọc máu, số ngày nằm viện và nằm tại khoa HSTC. Một số yếu tố tiên lượng tử vong được xác định bằng hồi quy đơn biến và đa biến. Kết quả: Trong 48 bệnh nhân, nam giới chiếm 58,3%. Độ tuổi trung bình là 69,6 ± 15,7 tuổi. Bệnh nhân nhiễm khuẩn nặng chiếm 52,1%. Tỷ lệ chuyển từ nhiễm khuẩn nặng thành sốc nhiễm khuẩn chiếm 60% (15/25). Tỷ lệ tuân thủ gói 1 giờ thấp (20,8%). Tỷ lệ tử vong là 16,7%. Số ngày thở máy trung bình là 3,8 ± 6,8 ngày, số ngày dùng vận mạch là 2,9 ± 3,7 ngày. Số ngày nằm viện là 16,3 ± 14,8 ngày và số ngày nằm HSTC là 7,5 ± 7,8 ngày. Các yếu tố tiên lượng tử vong: Độ thanh thải Lactate 24 giờ (ngưỡng cắt 30,3%, độ nhạy 75%, độ đặc hiệu 75%, OR=9, KTC 95%: 1,56-51,95)
điểm SOFA (ngưỡng cắt 8,5
độ nhạy 75%, độ đặc hiệu 85%, OR=17, KTC 95%: 2,75-104,97)
điểm APACHE II (ngưỡng cắt 20,5
độ nhạy 75%, độ đặc hiệu 85%, OR=12, KTC 95%: 2,03-71,01)
ARDS (OR=20,6
KTC 95%: 3,22-131,1)
DIC (OR=20,6
KTC 95%: 3,22-131,1), số tạng suy (ngưỡng cắt 2,5
độ nhạy 75%, độ đặc hiệu 75%
OR=9
KTC 95%: 1,56-51,95). Phân tích đa biến cho thấy ARDS là yếu tố nguy cơ độc lập ảnh hưởng đến tiên lượng, OR=34,7 (KTC 95%: 1,8- 683,5, P=0,02). Kết luận: Độ thanh thải Lactat 24 giờ, điểm SOFA, điểm APACHE II, ARDS, DIC và số tạng suy là các yếu tố tiên lượng tử vong. Trong đó, ARDS là yếu tố nguy cơ độc lập tiên lượng tử vong ở bệnh nhân nhiễm khuẩn nặng và sốc nhiễm khuẩn.To evaluate the treatment results and analyze some prognostic factors for mortality in patients with sepsis and septic shock at the Intensive Care Unit (ICU) of Tam Anh Hospital in Hanoi. Subjects and methods: A crosssectional descriptive study was conducted on 48 patients with sepsis or septic shock admitted to the ICU of Tam Anh General Hospital, Hanoi from September 2020 to March 2024. Treatment results were evaluated based on clinical outcome, mechanical ventilation duration, vasopressor use duration, number of dialysis sessions, length of hospital stay, and length of ICU stay. Several prognostic factors for mortality were determined using univariate and multivariate regression analysis. Results: Among the 48 patients, 58.3% were male. The average age was 69.6 ± 15.7 years. Patients with sepsis accounted for 52.1%. The rate of progression from sepsis to septic shock was 60% (15/25). The compliance rate with the 1-hour bundle was low (20.8%). The mortality rate was 16.7%. The average duration of mechanical ventilation was 3.8 ± 6.8 days, and the average duration of vasopressor use was 2.9 ± 3.7 days. The average length of hospital stay was 16.3 ± 14.8 days and the average length of ICU stay was 7.5 ± 7.8 days. Prognostic factors for mortality included: 24-hour lactate clearance (cutoff 30.3%, sensitivity 75%, specificity 75%, OR=9, 95% CI: 1.56-51.95), SOFA score (cutoff 8.5, sensitivity 75%, specificity 85%, OR=17, 95% CI: 2.75-104.97), APACHE II score (cutoff 20.5, sensitivity 75%, specificity 85%, OR=12, 95% CI: 2.03-71.01), ARDS (OR=20.6, 95% CI: 3.22-131.1), DIC (OR=20.6, 95% CI: 3.22- 131.1), and number of organ failures (cutoff 2.5, sensitivity 75%, specificity 75%, OR=9, 95% CI: 1.56-51.95). Multivariate analysis showed that ARDS was an independent risk factor for mortality, with OR=34.7 (95% CI: 1.8-683.5, p=0.02). Conclusion: 24-hour lactate clearance, SOFA score, APACHE II score, ARDS, DIC, and number of organ failures are prognostic factors for mortality. ARDS is an independent predictor of mortality in patients with sepsis and septic shock.

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