本文選題：評分系統(tǒng)　切入點：生物學指標　出處：《首都醫(yī)科大學學報》2017年04期

【摘要】：目的探討臨床生物學指標及評分系統(tǒng)對急診搶救室危重癥病人28 d死亡的預(yù)測能力,為臨床提供可靠的危重癥評估方法。方法對2014年1月至2015年5月在首都醫(yī)科大學附屬北京朝陽醫(yī)院急診科搶救室救治的所有內(nèi)科病人進行前瞻性研究,記錄病人28 d預(yù)后。入院24 h內(nèi)監(jiān)測生命體征、生化全項、凝血功能、動脈血氣分析、乳酸、C反應(yīng)蛋白等化驗室指標,行急性生理與慢性健康評分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ評分)、簡化急性生理學評分Ⅱ(simplified acute physiology scoreⅡ,SAPSⅡ評分)、序貫器官衰竭評分(sepsis-related organ failure assessment,SOFA評分)及急診膿毒癥死亡風險評分(mortality in emergency department sepsis,MEDS評分)。結(jié)果納入研究的病人2 089例,按28 d預(yù)后分為生存組(n=1 617)與死亡組(n=472)。兩組病人年齡、性別、體質(zhì)量指數(shù)及疾病種類等基礎(chǔ)情況差異無統(tǒng)計學意義(P0.05)。生存組與死亡組APACHEⅡ、SAPSⅡ、SOFA及MEDS評分分別為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±3.97,兩組間差異有統(tǒng)計學意義(P0.001)。死亡組C反應(yīng)蛋白及乳酸顯著升高,與生存組相比,差異具有統(tǒng)計學意義(P0.001)。Logistic回歸證實高血乳酸、APACHEⅡ、MEDS及SAPSⅡ評分為危重癥病人預(yù)后不良的危險因素。受試者工作特征曲線(receiver operating characteristic curve,ROC曲線)亦證實APACHEⅡ評分判斷預(yù)后效果最佳,其靈敏度和特異度分別為88.38%和82.93%。結(jié)論 4種評分系統(tǒng)中,APACHEⅡ評分對急診搶救室危重癥病人28 d預(yù)后預(yù)測價值最高,生物學指標——血乳酸可作為急診搶救室危重癥病人28 d預(yù)后的獨立危險因素。
[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，

本文編號：1706784