本文選題：膿毒癥　切入點(diǎn)：查爾森合并癥指數(shù)　出處：《天津醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:探討查爾森合并癥指數(shù)(Charlson comorbidities index,CCI)評(píng)分系統(tǒng)在評(píng)價(jià)基礎(chǔ)疾病對(duì)膿毒癥患者預(yù)后影響的臨床價(jià)值。方法:單中心、回顧性分析2012年12月至2014年7月入住天津醫(yī)科大學(xué)總醫(yī)院急診醫(yī)學(xué)科病房,出院診斷為膿毒癥的204例患者臨床資料。收集患者的一般資料,包括性別、年齡、既往基礎(chǔ)疾病、28d預(yù)后、出院時(shí)轉(zhuǎn)歸、住院天數(shù)等。計(jì)算入院時(shí)CCI、入院24小時(shí)的APACHEⅡ、SOFA評(píng)分。按照患者28d預(yù)后情況分為存活組和死亡組。采用SPSS 22.0統(tǒng)計(jì)軟件包進(jìn)行數(shù)據(jù)處理。計(jì)量資料表示為均數(shù)±標(biāo)準(zhǔn)差(±s),計(jì)量資料組間比較懫用獨(dú)立樣本t檢驗(yàn),計(jì)數(shù)資料的比較采用2檢驗(yàn),采用Spearman’s秩相關(guān)法進(jìn)行相關(guān)分析。多因素Logistic回歸方程分析性別、年齡、APACHEⅡ評(píng)分、SOFA評(píng)分、CCI評(píng)分等對(duì)預(yù)后的影響,以p0.05為差異具有統(tǒng)計(jì)學(xué)意義。每種評(píng)分方法對(duì)膿毒癥患者預(yù)后的預(yù)測(cè)價(jià)值采用受試者工作特征曲線(xiàn)(Receiver operating characteristic curves[ROC]curves)進(jìn)行評(píng)價(jià),計(jì)算曲線(xiàn)下面積,比較采用Hanley等的方法,以p0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果:204例患者中男性125例(61.3%),女性79例(38.7%);年齡(66.5±17.4)歲,膿毒癥121例(59.3%),嚴(yán)重膿毒癥66例(32.4%),膿毒癥休克17例(8.3%);存活組132例(64.7%),死亡組72例(35.3%)。單因素分析結(jié)果顯示,死亡組與存活組患者相比,年齡、APACHEⅡ評(píng)分、SOFA評(píng)分、CCI評(píng)分、感染情況、中/重度腎臟疾病及中/重度肝臟疾病比較有統(tǒng)計(jì)學(xué)意義(p0.05)。Spearman相關(guān)性分析顯示CCI評(píng)分與膿毒癥患者28d病死率相關(guān)(r=0.349,p0.001)。對(duì)不同CCI評(píng)分患者的病死率進(jìn)行趨勢(shì)2檢驗(yàn),結(jié)果顯示隨CCI分?jǐn)?shù)增加(0~7分),膿毒癥28d病死率增加(2趨勢(shì)=31.293,p0.05)。多因素Logistic回歸分析,結(jié)果顯示:APACHEⅡ評(píng)分[OR=1.185,95%CI(1.112,1.263),p0.001],CCI評(píng)分[OR=1.281,95%CI(1.067,1.538),p=0.008],是評(píng)估患者28d預(yù)后的獨(dú)立風(fēng)險(xiǎn)因素。繪制三種評(píng)分評(píng)估膿毒癥患者28d預(yù)后的ROC曲線(xiàn),APACHEⅡ評(píng)分曲線(xiàn)下面積為0.816[95%CI(0.758,0.874),p0.001],SOFA評(píng)分曲線(xiàn)下面積為0.763[95%CI(0.696,0.829),p0.001],CCI評(píng)分曲線(xiàn)下面積為0.708[95%CI(0.635,0.782),p0.001]。CCI評(píng)分與APACHEⅡ評(píng)分曲線(xiàn)下面積間差異有統(tǒng)計(jì)學(xué)意義(Z=2.269,P0.05),CCI評(píng)分與SOFA評(píng)分曲線(xiàn)下面積間差異沒(méi)有統(tǒng)計(jì)學(xué)意義(Z=1.095,P0.05)。CCI評(píng)分的預(yù)測(cè)效能稍遜于APACHEⅡ評(píng)分,與SOFA評(píng)分相當(dāng)。結(jié)論:CCI評(píng)分是預(yù)測(cè)膿毒癥患者預(yù)后的獨(dú)立因素,CCI評(píng)分系統(tǒng)可以較好評(píng)估膿毒癥患者28d預(yù)后。
[Abstract]:Objective: to evaluate the clinical value of Charlson comorbidities index (Charlson comorbidities) scoring system in evaluating the prognosis of patients with sepsis. From December 2012 to July 2014, we retrospectively analyzed the clinical data of 204 patients who were admitted to the Department of Emergency Medicine, General Hospital of Tianjin Medical University from December 2012 to July 2014, and who were discharged from the hospital and diagnosed as sepsis. The prognosis of the previous underlying diseases was 28 days, and the prognosis of the patients returned when they were discharged from the hospital. The APACHE 鈪，

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