胃肠功能评分对危重症患者预后评估的价值

发布时间：2018-11-16 17:42

【摘要】：目的:通过监测入住重症监护室患者的GIF评分、AGI分级、腹内压值与SOFA评分以及患者预后转归进行统计分析,明确各类胃肠道评分系统对患者预后的评估价值。方法:选择2015年11月至2016年5月入住重症监护室超过24小时的患者。监测患者入住ICU时腹内压水平,记录其第一天序贯器官功能障碍评分、GIF评分、AGI分级、以及是否行机械通气,如使用机械通气则机械通气时间、入住重症监护室时间、病因分析以及患者28天存活率;并记录患者一般情况,如年龄、性别、体重指数以及是否患有糖尿病等。应用SPSS17.0统计学软件来分析GIF评分,AGI分级以及腹内压与其SOFA评分的相关性,以及各评分患者的重症监护室住院天数,28天存活率,以及机械通气时间影响,两组间计量资料间的比较使用t检验,计数资料间使用卡方检验,多组间比较则采用秩和检验。结果:1.重症患者中死亡组的GIF评分、AGI分级以及腹内压值均高于存活患者,P值均小于0.05,;2.GIF评分、AGI分级以及腹内压值与SOFA评分之间存在显性的正相关,但相关程度不密切,P均小于0.01,但r值小于0.5;3.GIF评分、AGI分级各等级间患者机械通气时间不全相等,P小于0.05,GIF评分各分级患者在ICU停留时间亦不全相等(P0.05),但AGI分级各等级于ICU停留时间无明显差异,P值为0.234,腹内高压患者ICU停留时间以及机械通气时间均较腹内压正常患者长,P值均小于0.05;4.胃肠道各类评分对患者预后的评估价值的ROC曲线中,GIF评分+SOFA评分的曲线下面积最大,AUC=0.729,其次为AGI分级+SOFA评分,曲线下面积为0.718。结论:随着GIF评分、AGI分级的增高患者的死亡率亦增高,GIF评分以及AGI分级均是重症患者死亡率的独立危险因素,GIF评分各等级间以及腹内压等级对患者的ICU停留时间以及机械通气时间均存在一定的影响,但AGI分级各等级间与患者的ICU停留时间没有区别,但影响患者的机械通气时间,而各评分对患者预后的预测亦存在不同的的价值,以GIF评分+SOFA评分的价值最高。
[Abstract]:Objective: to determine the value of various gastrointestinal scoring systems in evaluating the prognosis of patients in intensive care unit (ICU) by monitoring their GIF score, AGI grade, intra-abdominal pressure and SOFA score, and the prognosis of the patients. Methods: patients admitted to ICU for more than 24 hours from November 2015 to May 2016 were selected. The abdominal pressure level was monitored at the time of admission to ICU, and the score of sequential organ dysfunction, GIF score, AGI grade, and the duration of mechanical ventilation, if mechanical ventilation was used, and the duration of admission to intensive care unit were recorded on the first day. Etiology analysis and patient survival rate of 28 days; The patient's general information, such as age, sex, body mass index and diabetes, was recorded. SPSS17.0 statistical software was used to analyze the correlation between GIF score, AGI grade, intra-abdominal pressure and SOFA score, as well as the days of intensive care unit hospitalization, the survival rate of 28 days, and the effect of mechanical ventilation time. T test was used for comparison of measurement data between two groups, chi-square test was used for counting data, and rank sum test was used for multi-group comparison. The result is 1: 1. The scores of GIF, AGI and intra-abdominal pressure in the death group were higher than those in the surviving group (P < 0.05). There was a significant positive correlation between 2.GIF score, AGI grade, intra-abdominal pressure and SOFA score, but the correlation was not close (P < 0.01, r < 0.5). In the 3.GIF score, the mechanical ventilation time of the patients in the AGI grade was not equal, and the ICU residence time of the patients in the AGI grade was not equal (P0.05), but there was no significant difference in the ICU residence time between the AGI grade and the ICU grade. P value was 0.234. ICU residence time and mechanical ventilation time in patients with intraabdominal hypertension were longer than those in patients with normal abdominal pressure (P < 0.05). 4. In the ROC curve, GIF score SOFA score had the largest area under the curve, AUC=0.729, was followed by AGI grade SOFA score, and the area under the curve was 0.718. Conclusion: with the increase of GIF score, the death rate of patients with higher AGI grade is also increased. GIF score and AGI grade are independent risk factors of mortality in severe patients. GIF score and intra-abdominal pressure had some influence on ICU residence time and mechanical ventilation time, but there was no difference between AGI grade and patient's ICU residence time, but it affected patient's mechanical ventilation time. The prognostic value of each score was different, and the value of GIF score SOFA score was the highest.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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