摘要
目的通过引入评价胃肠道功能衰竭的急性肠胃损伤(acute gastrointestinal injury,AGI)评分,形成改良序贯器官衰竭评价(sequential organ failure assessment,SOFA),探讨SOFA评分与改良SOFA评分对重症监护室(intensive care unit,ICU)或急诊重症监护室(emergency intensive care unit,EICU)脓毒症患者病情评估的价值。方法选取河南科技大学临床医学院附属黄河三门峡医院ICU/EICU收治的脓毒症或感染性休克患者40例。对其入院24 h(首日)及ICU/EICU期间疾病最重阶段24 h的各项生理参数和实验检查结果分别进行SOFA评分和改良SOFA评分。以28 d死亡与否分为存活组(n=27)和死亡组(n=13),根据两组之间的评分及在同一组不同时间段评分的差异,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),计算ROC曲线下面积,比较两种评分系统对患者预后判断的能力。结果存活组入科后首日改良SOFA评分、最高改良SOFA评分均低于死亡组;两组评值符合正态分布,差异有统计学意义(t=-4.600,P<0.01;t=-7.000,P<0.01)。首日SOFA评分ROC曲线下面积0.735,首日改良SOFA评分ROC曲线下面积0.754,最高SOFA评分ROC曲线下面积0.865,最高改良SOFA评分ROC曲线下面积0.905。首日SOFA值与改良首日SOFA值ROC曲线下面积比较,差异无统计学意义(Z=1.183,P>0.05)。最高SOFA值与最高改良SOFA值ROC曲线下面积比较,差异有统计学意义(Z=2.645,P<0.05)。结论最高SOFA评分值对脓毒症患者的预后评估优于首日SOFA评分,改良SOFA评分对ICU/EICU脓毒症患者预后的预测效果优于SOFA评分,可用改良后的SOFA评分代替SOFA评分对脓毒症患者进行预后评估。
Objective The objective of this study was to explore the value of the Modified Sequential Organ Failure Assessment（SOFA） Score by means of introducing the evaluation of Acute Gastrointestinal Injury（AGI） Score versus SOFA Score in illness assessment of septic ICU or EICU patients and to compare their strengths and weakness. Methods A total of 40 cases of sepsis or septic shock ICU or EICU patients admitted in Yellow River Sanmenxia Hospital Affiliated to Henan University of Science and Technology were selected. Their physiological parameters and laboratory test results at the initial 24 h and its most serious 24 h were evaluated using SOFA Score and Modified SOFA Score and they were divided into a survival group（n=27） and a death group（n=13） based on predicted mortality at the time point of 28 d. The ROC curve was drawn for each scoring system and the area under the two scoring systems was measured and compared. Results The first day Modified SOFA Score and the highest Modified Score in survival group were lower than that of death group; the score of the two groups showed the normal distribution and the differences were statistically significant（t=-4.600,P0.01;t=-7.000,P0.01）. The area under the ROC curve of the first day SOFA score was 0.735, while the area under the ROC curve of the first day Modified SOFA score was 0.754, and difference was not statistically significant（Z=1.183,P0.05）. The area under the ROC curve of the highest SOFA score was 0.865, while the area under the ROC curve of the highest Modified SOFA score was 0.905（Z=2.645,P0.05）. Conclusions The sepsis prognosis of the highest SOFA score for patients is better than that of the first day SOFA score; and the sepsis prognosis of the Modified SOFA score in ICU/EICU is better than that of the SOFA score. Therefore, the SOFA score used to evaluate prognosis of patients with sepsis can be replaced by the Modified SOFA score.
出处
《中华灾害救援医学》
2017年第10期550-553,共4页
Chinese Journal of Disaster Medicine
关键词
脓毒症
序贯器官衰竭评价
病情评估
sepsis
sequential organ failure assessment
disease evaluation
