胃肠功能障碍评分在危重患者中的应用价值初探

发布时间：2018-04-09 22:12

  本文选题：疾病严重程度评分　切入点：急性生理与慢性健康评分　出处：《南华大学》2014年硕士论文

【摘要】：目的：通过对重症病房（ICU）重症患者胃肠功能状态与预后相关性进行分析，探讨胃肠功能障碍评分在危重患者中的应用价值。对象与方法：收集从2013年1月1日至2013年7月1日在郴州市第一人民医院ICU住院时间超过24小时的年龄大于18岁的成年患者465例的性别、年龄、入住ICU的主要诊断、是否急诊手术、血小板计数、胆红素水平、血清肌酐水平、尿量、以及APACHEⅡ评分、首日SOFA评分、既往慢性疾病病史、是否进行机械通气、ICU住院天数、医院住院天数、机械通气天数、前三日GIF评分、胃肠营养入量、住院死亡率、ICU获得性感染等临床资料。使用SPSS17.0统计软件进行数据统计。结果：ICU患者首日即发生胃肠功能障碍的患者比例高达84.9%；以患者是否死亡进行分组分析，两组患者首日GIF评分及前三日平均GIF评分有统计学意义，同时提示预后差的患者胃肠功能状态也差；不同病因入住ICU患者胃肠功能障碍发生存在差异，无论是在首日的GIF评分还是前三日GIF评分平均值因脓毒症入住ICU患者与因循环系统问题、呼吸系统问题、多发伤及神经系统问题等入住ICU的患者比较无统计学意义（P0.05），但这几类患者与因胃肠功能问题入住ICU患者GIF评分比较有统计学意义（P0.05）；非胃肠系统疾病入住ICU的患者首日是否存在胃肠功能障碍进行分组分析，结果提示在非胃肠系统疾病入住ICU的患者中提示疾病严重程度的血压水平、血糖水平、基础疾病评分、APACHEII评分、首日SOFA评分均无统计学意义(p0.05)，而提示预后的指标ICU住院天数、医院住院天数及死亡率方面存在统计学意义（p0.05）；对入ICU首日即存在胃肠功能障碍的患者进行原发胃肠功能障碍及继发胃肠功能障碍分组。原发胃肠功能障碍为入住ICU主因胃肠系统疾病，继发胃肠功能障碍为入住ICU主因为肺胃肠系统疾病。结果提示在入住ICU患者是否因胃肠系统疾病在疾病严重程度的最低血压水平、尿素氮水平、血小板水平、基础疾病评分、APACHEII评分、首日SOFA评分、第一天GIF评分及前三日平均GIF评分均有统计学意义(p0.05)，而提示预后的指标ICU住院天数、医院住院天数、机械通气天数存在统计学意义（p0.05），但是死亡率方面无统计学意义（P0.05）；而以首日是否发生胃肠营养不耐受（food intolerance FI）进行分组分析提示首日FI并不能准确反映患者的病情严重程度；而前三日平均GIF评分提示前三日总体FI时患者病情更严重。而对患者首日是否存在腹腔高压（intra-abdominal hypertension IAH）或者腹腔间室综合征（abdominalcompartment syndrome ACS）进行分组分析，提示IAH组患者PACHEII评分、SOFA评分、死亡率显著高于无IAH组。对APACHEII评分、SOFA评分及平均GIF评分进行Logistic回归分析提示平均GIF评分同APACHEII评分及SOFA评分均是患者死亡的危险因素；对APACHEII评分、SOFA评分及平均GIF评分作受试者生存工作曲线分析提示在判别患者死亡方面GIF评分具备APACHEII评分及SOFA评分的同等的校验力。结论：重症患者胃肠功能障碍发生率高，不同疾病类型发生胃肠功能障碍严重程度不一致，，使用GIF评分进行患者病情严重程度评估应当注意患者的疾病类型，首日及前三日平均的GIF评分高提示患者的预后差。前三日总体评估存在FI患者病情更严重。首日即存在IAH患者预后差。高的平均GIF分值是患者死亡危险因素。平均GIF评分在判别患者死亡方面具备APACHEII评分及SOFA评分的同等的校验力。
[Abstract]:Objective : To analyze the relationship between gastrointestinal function status and prognosis in intensive care unit ( ICU ) , and to explore the application value of gastrointestinal dysfunction score in critically ill patients .
Group analysis was carried out on whether the patient died or not , the first GIF score and the average GIF score of the first three days were statistically significant in both groups , and the difference of gastrointestinal function was also suggested in patients with poor prognosis .
There was a difference in gastrointestinal dysfunction in ICU patients with different etiologies , whether on the first day GIF score or the first three days , the average of GIF score was not statistically significant ( P0.05 ) . However , there was a significant difference between these patients and the GIF score of ICU patients due to gastrointestinal function ( P0.05 ) .
There was no statistical significance ( p . 05 ) in the patients with non - gastrointestinal system disease admitted to ICU on the first day . The results suggested that in patients with non - gastrointestinal system disease admitted to ICU , there was no statistical significance ( p . 05 ) for the severity of disease , blood sugar level , basic disease score , APACHEII score and SOFA score of the first day ( p . 05 ) .
Results : In ICU patients , there was statistical significance ( p < 0.05 ) for the most low blood pressure level , urea nitrogen level , platelet level , basic disease score , APACHEII score , first SOFA score , first day GIF score and the first three days in ICU patients .
It was suggested that the first day of FI did not accurately reflect the severity of the patient ' s condition .
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