Wichmann M W, Inthorn D, Andress H J, Schildberg F W
Department of Surgery, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany.
Intensive Care Med. 2000 Feb;26(2):167-72. doi: 10.1007/s001340050041.
Laboratory studies demonstrated significant detrimental effects of male sex-steroids (testosterone) on immune functions following hemorrhagic shock and soft-tissue trauma. Moreover, better survival of female mice subjected to severe sepsis was observed when compared to male animals. The aims of the present study were to evaluate whether or not gender differences regarding incidence and mortality of severe sepsis do exist in surgical intensive care patients and to elucidate the influence of patient age on incidence and mortality of severe sepsis/septic shock.
Data base review of prospectively collected data from surgical intensive care patients.
Surgical intensive care unit of the department of surgery of a university hospital.
Prospectively collected data of 4,218 intensive care patients (2,709 male, 1,509 female).
Significantly fewer female patients were referred to the intensive care unit (6.6 % vs 10.8 % of all patients; P < 0.05) leading to a significantly smaller proportion of female intensive care patients (35.8% vs 64.2%). No gender differences regarding number of failing organs or surgical procedure (exception vascular surgery) were observed in patients with and without severe sepsis/septic shock, indicating that the patients studied are comparable regarding general health prior to admission to SICU. Among all female patients referred to SICU only 7.6 % developed severe sepsis/septic shock, while 10.4% of all male patients suffered from severe sepsis or septic shock (P < 0.05). This gender difference results from a significantly lower incidence of severe sepsis/ septic shock in female patients between 60 and 79 years. No gender difference regarding mortality rates of severe sepsis/septic shock was observed (men 64.9 %, women 65.5%).
Our results indicate a significantly smaller number of female patients requiring intensive care as well as a significantly lower incidence of severe sepsis/septic shock in female intensive care patients. Mortality from severe sepsis/ septic shock, however, is not affected by gender.
实验室研究表明，男性甾体激素（睾酮）对失血性休克和软组织创伤后的免疫功能有显著的有害影响。此外，与雄性动物相比，观察到遭受严重脓毒症的雌性小鼠存活率更高。本研究的目的是评估外科重症监护患者中严重脓毒症的发病率和死亡率是否存在性别差异，并阐明患者年龄对严重脓毒症/脓毒性休克的发病率和死亡率的影响。
对前瞻性收集的外科重症监护患者数据进行数据库回顾。
大学医院外科的外科重症监护病房。
前瞻性收集的4218名重症监护患者的数据（男性2709名，女性1509名）。
转入重症监护病房的女性患者明显较少（占所有患者的6.6%，而男性为10.8%；P<0.05），导致女性重症监护患者的比例明显较小（35.8%对64.2%）。在患有和未患有严重脓毒症/脓毒性休克的患者中，未观察到器官衰竭数量或手术操作（血管手术除外）的性别差异，这表明所研究的患者在入住外科重症监护病房之前的总体健康状况具有可比性。在转入外科重症监护病房的所有女性患者中，只有7.6%发生了严重脓毒症/脓毒性休克，而所有男性患者中有10.4%患有严重脓毒症或脓毒性休克（P<0.05）。这种性别差异是由于60至79岁女性患者中严重脓毒症/脓毒性休克的发病率显著较低。在严重脓毒症/脓毒性休克的死亡率方面未观察到性别差异（男性为64.9%，女性为65.5%）。
我们的结果表明，需要重症监护的女性患者数量明显较少，并且女性重症监护患者中严重脓毒症/脓毒性休克的发病率也显著较低。然而，严重脓毒症/脓毒性休克的死亡率不受性别的影响。
