摘要
目的 观察本研究创立的脓毒症单病种数据监测系统在改善脓毒症处理中的作用及其预测脓毒症患者死亡风险的价值。方法 回顾性纳入2013年9月22日至2017年5月5日所有入住中山大学附属第一医院重症医学科的脓毒症患者，使用脓毒症单病种质控管理系统，对本研究设置的25个质控指标进行监控，并分类为及时性、规范性和结果性指标。通过系统监测判断临床治疗是否达到这些质控指标，并对未达标的项目定义为可疑项，利用受试者工作特征曲线（ROC曲线）通过可疑项数目预测患者的死亡风险。结果 本研究共纳入1 220例脓毒症患者，其中男性805例，女性415例，年龄（59±17）岁，急性生理与慢性健康评分为（19±8）分。可疑项总数预测28 d死亡风险的ROC曲线下面积为0.70，当可疑项总数〉6时，预测28 d内死亡风险的敏感度为68.0%，特异度61.0%；结果性指标可疑项数预测28 d死亡风险的ROC曲线下面积为0.89，当结果性指标可疑数〉1时，预测28 d内死亡风险的敏感度为88.0%，特异度为78.0%。可疑项总数预测90 d死亡风险的ROC曲线下面积为0.73，当可疑项总数〉7时，预测90 d内死亡风险的敏感度60.0%，特异度74.0%；结果性指标可疑项数预测90 d死亡风险的ROC曲线下面积为0.92，当结果性指标可疑数〉1时，预测90 d内死亡风险的敏感度88.0%，特异度81.0%。结论 单中心的数据显示，本研究创立的脓毒症单病种数据监测系统可评估临床医生按照规定处理脓毒症患者的达标情况，未达标项数可反映脓毒症患者的死亡风险。
Objective To observe the effect of sepsis single-disease manage system on the improvement of sepsis treatment and the value in predicting mortality in patients with sepsis.Methods A retrospective study was conducted. Patients with sepsis admitted to the Department of Surgical Intensive Care Unit of Sun Yat-Sen University First Affiliated Hospital from September 22, 2013 to May 5, 2015 were enrolled in this study. Sepsis single-disease manage system （Rui Xin clinical data manage system, China data, China） was used to monitor 25 clinical quality parameters, consisting of timeliness, normalization and outcome parameters. Based on whether these quality parameters could be completed or not, the clinical practice was evaluated by the system. The unachieved quality parameter was defined as suspicious parameters, and these suspicious parameters were used to predict mortality of patients with receiver operating characteristic curve （ROC）.Results A total of 1 220 patients with sepsis were enrolled, included 805 males and 415 females. The mean age was （59±17） years, and acute physiology and chronic health evaluation （APACHE Ⅱ） scores was 19±8. The area under ROC curve of total suspicious numbers for predicting 28-day mortality was 0.70; when the suspicious parameters number was more than 6, the sensitivity was 68.0% and the specificity was 61.0% for predicting 28-day mortality. In addition, the area under ROC curve of outcome suspicious number for predicting 28-day mortality was 0.89; when the suspicious outcome parameters numbers was more than 1, the sensitivity was 88.0% and the specificity was 78.0% for predicting 28-day mortality. Moreover, the area under ROC curve of total suspicious number for predicting 90-day mortality was 0.73; when the total suspicious parameters number was more than 7, the sensitivity was 60.0% and the specificity was 74.0% for predicting 90-day mortality. Finally, the area under ROC curve of outcome suspicious numbers for predicting 90-day mortality was 0.92; when suspicious
作者
陈娟
王陆豪
欧阳彬
陈敏英
吴健锋
刘勇军
刘紫锰
管向东
Chen Juan, Wang Luhao, Ouyang Bin, Chen Minying, Wu Jianfeng, Liu Yongjun, Liu Zimeng, Guan Xiangdong.(Department of Surgical Intensive Care Unit, Sun Yat-sen University First Affiliated Hospital, Guangzhou 510080, Chin)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2018年第13期1019-1023,共5页
National Medical Journal of China
