影响急诊危重症病人预后的危险因素分析

发布时间：2018-04-03 20:27

  本文选题：评分系统　切入点：生物学指标　出处：《首都医科大学学报》2017年04期

【摘要】：目的探讨临床生物学指标及评分系统对急诊抢救室危重症病人28 d死亡的预测能力,为临床提供可靠的危重症评估方法。方法对2014年1月至2015年5月在首都医科大学附属北京朝阳医院急诊科抢救室救治的所有内科病人进行前瞻性研究,记录病人28 d预后。入院24 h内监测生命体征、生化全项、凝血功能、动脉血气分析、乳酸、C反应蛋白等化验室指标,行急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ评分)、简化急性生理学评分Ⅱ(simplified acute physiology scoreⅡ,SAPSⅡ评分)、序贯器官衰竭评分(sepsis-related organ failure assessment,SOFA评分)及急诊脓毒症死亡风险评分(mortality in emergency department sepsis,MEDS评分)。结果纳入研究的病人2 089例,按28 d预后分为生存组(n=1 617)与死亡组(n=472)。两组病人年龄、性别、体质量指数及疾病种类等基础情况差异无统计学意义(P0.05)。生存组与死亡组APACHEⅡ、SAPSⅡ、SOFA及MEDS评分分别为11.64±4.33 vs 20.87±5.46;25.23±8.67 vs 42.96±12.97;6.28±4.54 vs 10.98±5.89;1.86±1.80 vs 4.90±3.97,两组间差异有统计学意义(P0.001)。死亡组C反应蛋白及乳酸显著升高,与生存组相比,差异具有统计学意义(P0.001)。Logistic回归证实高血乳酸、APACHEⅡ、MEDS及SAPSⅡ评分为危重症病人预后不良的危险因素。受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)亦证实APACHEⅡ评分判断预后效果最佳,其灵敏度和特异度分别为88.38%和82.93%。结论 4种评分系统中,APACHEⅡ评分对急诊抢救室危重症病人28 d预后预测价值最高,生物学指标——血乳酸可作为急诊抢救室危重症病人28 d预后的独立危险因素。
[Abstract]:Objective to explore the predictive ability of clinical biological indexes and scoring system for 28 days death of critical patients in emergency rescue room, and to provide a reliable method for clinical evaluation of critical diseases.Methods from January 2014 to May 2015, all the medical patients treated in the emergency department of Beijing Chaoyang Hospital affiliated to Capital Medical University were studied prospectively, and the prognosis of the patients was recorded in 28 days.Vital signs, biochemistry, coagulation function, arterial blood gas analysis, lactate C-reactive protein and other laboratory indexes were monitored within 24 hours after admission.Acute physiology and chronic health evaluation 鈪，

本文编号：1706784