發(fā)布時(shí)間：2018-11-16 17:42

【摘要】：目的:通過(guò)監(jiān)測(cè)入住重癥監(jiān)護(hù)室患者的GIF評(píng)分、AGI分級(jí)、腹內(nèi)壓值與SOFA評(píng)分以及患者預(yù)后轉(zhuǎn)歸進(jìn)行統(tǒng)計(jì)分析,明確各類胃腸道評(píng)分系統(tǒng)對(duì)患者預(yù)后的評(píng)估價(jià)值。方法:選擇2015年11月至2016年5月入住重癥監(jiān)護(hù)室超過(guò)24小時(shí)的患者。監(jiān)測(cè)患者入住ICU時(shí)腹內(nèi)壓水平,記錄其第一天序貫器官功能障礙評(píng)分、GIF評(píng)分、AGI分級(jí)、以及是否行機(jī)械通氣,如使用機(jī)械通氣則機(jī)械通氣時(shí)間、入住重癥監(jiān)護(hù)室時(shí)間、病因分析以及患者28天存活率;并記錄患者一般情況,如年齡、性別、體重指數(shù)以及是否患有糖尿病等。應(yīng)用SPSS17.0統(tǒng)計(jì)學(xué)軟件來(lái)分析GIF評(píng)分,AGI分級(jí)以及腹內(nèi)壓與其SOFA評(píng)分的相關(guān)性,以及各評(píng)分患者的重癥監(jiān)護(hù)室住院天數(shù),28天存活率,以及機(jī)械通氣時(shí)間影響,兩組間計(jì)量資料間的比較使用t檢驗(yàn),計(jì)數(shù)資料間使用卡方檢驗(yàn),多組間比較則采用秩和檢驗(yàn)。結(jié)果:1.重癥患者中死亡組的GIF評(píng)分、AGI分級(jí)以及腹內(nèi)壓值均高于存活患者,P值均小于0.05,;2.GIF評(píng)分、AGI分級(jí)以及腹內(nèi)壓值與SOFA評(píng)分之間存在顯性的正相關(guān),但相關(guān)程度不密切,P均小于0.01,但r值小于0.5;3.GIF評(píng)分、AGI分級(jí)各等級(jí)間患者機(jī)械通氣時(shí)間不全相等,P小于0.05,GIF評(píng)分各分級(jí)患者在ICU停留時(shí)間亦不全相等(P0.05),但AGI分級(jí)各等級(jí)于ICU停留時(shí)間無(wú)明顯差異,P值為0.234,腹內(nèi)高壓患者ICU停留時(shí)間以及機(jī)械通氣時(shí)間均較腹內(nèi)壓正�；颊唛L(zhǎng),P值均小于0.05;4.胃腸道各類評(píng)分對(duì)患者預(yù)后的評(píng)估價(jià)值的ROC曲線中,GIF評(píng)分+SOFA評(píng)分的曲線下面積最大,AUC=0.729,其次為AGI分級(jí)+SOFA評(píng)分,曲線下面積為0.718。結(jié)論:隨著GIF評(píng)分、AGI分級(jí)的增高患者的死亡率亦增高,GIF評(píng)分以及AGI分級(jí)均是重癥患者死亡率的獨(dú)立危險(xiǎn)因素,GIF評(píng)分各等級(jí)間以及腹內(nèi)壓等級(jí)對(duì)患者的ICU停留時(shí)間以及機(jī)械通氣時(shí)間均存在一定的影響,但AGI分級(jí)各等級(jí)間與患者的ICU停留時(shí)間沒(méi)有區(qū)別,但影響患者的機(jī)械通氣時(shí)間,而各評(píng)分對(duì)患者預(yù)后的預(yù)測(cè)亦存在不同的的價(jià)值,以GIF評(píng)分+SOFA評(píng)分的價(jià)值最高。
[Abstract]:Objective: to determine the value of various gastrointestinal scoring systems in evaluating the prognosis of patients in intensive care unit (ICU) by monitoring their GIF score, AGI grade, intra-abdominal pressure and SOFA score, and the prognosis of the patients. Methods: patients admitted to ICU for more than 24 hours from November 2015 to May 2016 were selected. The abdominal pressure level was monitored at the time of admission to ICU, and the score of sequential organ dysfunction, GIF score, AGI grade, and the duration of mechanical ventilation, if mechanical ventilation was used, and the duration of admission to intensive care unit were recorded on the first day. Etiology analysis and patient survival rate of 28 days; The patient's general information, such as age, sex, body mass index and diabetes, was recorded. SPSS17.0 statistical software was used to analyze the correlation between GIF score, AGI grade, intra-abdominal pressure and SOFA score, as well as the days of intensive care unit hospitalization, the survival rate of 28 days, and the effect of mechanical ventilation time. T test was used for comparison of measurement data between two groups, chi-square test was used for counting data, and rank sum test was used for multi-group comparison. The result is 1: 1. The scores of GIF, AGI and intra-abdominal pressure in the death group were higher than those in the surviving group (P < 0.05). There was a significant positive correlation between 2.GIF score, AGI grade, intra-abdominal pressure and SOFA score, but the correlation was not close (P < 0.01, r < 0.5). In the 3.GIF score, the mechanical ventilation time of the patients in the AGI grade was not equal, and the ICU residence time of the patients in the AGI grade was not equal (P0.05), but there was no significant difference in the ICU residence time between the AGI grade and the ICU grade. P value was 0.234. ICU residence time and mechanical ventilation time in patients with intraabdominal hypertension were longer than those in patients with normal abdominal pressure (P < 0.05). 4. In the ROC curve, GIF score SOFA score had the largest area under the curve, AUC=0.729, was followed by AGI grade SOFA score, and the area under the curve was 0.718. Conclusion: with the increase of GIF score, the death rate of patients with higher AGI grade is also increased. GIF score and AGI grade are independent risk factors of mortality in severe patients. GIF score and intra-abdominal pressure had some influence on ICU residence time and mechanical ventilation time, but there was no difference between AGI grade and patient's ICU residence time, but it affected patient's mechanical ventilation time. The prognostic value of each score was different, and the value of GIF score SOFA score was the highest.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R459.7

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