中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2015年
1期
55-61
,共7页
严重脓毒症%SAPS 3-PIRO%APACHEⅡ%SOFA%SAPSⅢ%MEDS
嚴重膿毒癥%SAPS 3-PIRO%APACHEⅡ%SOFA%SAPSⅢ%MEDS
엄중농독증%SAPS 3-PIRO%APACHEⅡ%SOFA%SAPSⅢ%MEDS
Severe sepsis%SAPS 3-PIRO%APACHE Ⅱ%SOFA%SAPS Ⅲ%MEDS
目的 探求SAPS 3-PIRO评分方法对急诊ICU严重脓毒症患者预后评价的适用性.方法 对2008年1月至2011年12月,在首都医科大学附属北京朝阳医院急诊ICU救治的677例脓毒症患者进行回顾性研究.患者入选标准:年龄≥18岁,在急诊ICU存活时间≥24 h,符合2001年华盛顿“国际脓毒症定义会议”推荐的严重脓毒症诊断标准、脏器损伤标准,亦参照该会议制定的标准,不符合上述入选标准的予以排除.在入选时间段内重复在ICU治疗的患者取第一次入院的数据.收集所有入选病例的姓名、年龄、性别、既往病史.第1天生命体征、血常规、血气、生化、凝血四项、尿量.根据24 h内最差的数据进行APACHEⅡ、SOFA、SAPSⅢ、SAPS-3PIRO、MEDS评分.以患者28 d转归情况为终点,记录存活和死亡例数.使用SPSS 13.0统计软件分析数据,正态分布的计量资料均采用均数±标准差(-x±s)表示.生存组与死亡组间,正态分布、方差齐的计量资料采用独立样本f检验,方差不齐采用t'检验,计数资料采用x2检验.按患者死亡或生存,进行二分类Logistic回归分析,建立回归方程;采用受试者工作特征曲线(ROC曲线)评价评分系统,对预后的判定能力并确定预后的界值,ROC曲线下面积(AUG)比较用Z检验.以P＜0.05为差异具有统计学意义.结果 APACHEⅡ、SOFA、SAPSⅢ、SAPS 3-PIRO和MEDS评分,是入选严重脓毒症患者28 d死亡的独立预测因素.通过SAPS 3-PIRO、APACHEⅡ、SOFA、SAPSⅢ和MEDS评分的ROC曲线及AUC比较:SAPS 3-PIRO评分与APACHEⅡ、SOFA和SAPSⅢ评分,预测预后的能力相当,MEDS评分预测预后的能力优于SAPS 3-PIRO、APACHEⅡ、SOFA和SAPSⅢ评分.结论 (1) MEDS评分预测预后的能力优于SAPS 3-PIRO、APACHEⅡ、SOFA和SAPSⅢ评分,MEDS具有良好的预测28 d死亡的能力,MEDS≥11分是此类患者病死率增加的标志.(2) SAPS 3-PIRO与APACHEⅡ、SOFA和SAPSⅢ评分预测能力相当,也可用于对急诊ICU严重脓毒症患者的预后进行预测.
目的 探求SAPS 3-PIRO評分方法對急診ICU嚴重膿毒癥患者預後評價的適用性.方法 對2008年1月至2011年12月,在首都醫科大學附屬北京朝暘醫院急診ICU救治的677例膿毒癥患者進行迴顧性研究.患者入選標準:年齡≥18歲,在急診ICU存活時間≥24 h,符閤2001年華盛頓“國際膿毒癥定義會議”推薦的嚴重膿毒癥診斷標準、髒器損傷標準,亦參照該會議製定的標準,不符閤上述入選標準的予以排除.在入選時間段內重複在ICU治療的患者取第一次入院的數據.收集所有入選病例的姓名、年齡、性彆、既往病史.第1天生命體徵、血常規、血氣、生化、凝血四項、尿量.根據24 h內最差的數據進行APACHEⅡ、SOFA、SAPSⅢ、SAPS-3PIRO、MEDS評分.以患者28 d轉歸情況為終點,記錄存活和死亡例數.使用SPSS 13.0統計軟件分析數據,正態分佈的計量資料均採用均數±標準差(-x±s)錶示.生存組與死亡組間,正態分佈、方差齊的計量資料採用獨立樣本f檢驗,方差不齊採用t'檢驗,計數資料採用x2檢驗.按患者死亡或生存,進行二分類Logistic迴歸分析,建立迴歸方程;採用受試者工作特徵麯線(ROC麯線)評價評分繫統,對預後的判定能力併確定預後的界值,ROC麯線下麵積(AUG)比較用Z檢驗.以P＜0.05為差異具有統計學意義.結果 APACHEⅡ、SOFA、SAPSⅢ、SAPS 3-PIRO和MEDS評分,是入選嚴重膿毒癥患者28 d死亡的獨立預測因素.通過SAPS 3-PIRO、APACHEⅡ、SOFA、SAPSⅢ和MEDS評分的ROC麯線及AUC比較:SAPS 3-PIRO評分與APACHEⅡ、SOFA和SAPSⅢ評分,預測預後的能力相噹,MEDS評分預測預後的能力優于SAPS 3-PIRO、APACHEⅡ、SOFA和SAPSⅢ評分.結論 (1) MEDS評分預測預後的能力優于SAPS 3-PIRO、APACHEⅡ、SOFA和SAPSⅢ評分,MEDS具有良好的預測28 d死亡的能力,MEDS≥11分是此類患者病死率增加的標誌.(2) SAPS 3-PIRO與APACHEⅡ、SOFA和SAPSⅢ評分預測能力相噹,也可用于對急診ICU嚴重膿毒癥患者的預後進行預測.
목적 탐구SAPS 3-PIRO평분방법대급진ICU엄중농독증환자예후평개적괄용성.방법 대2008년1월지2011년12월,재수도의과대학부속북경조양의원급진ICU구치적677례농독증환자진행회고성연구.환자입선표준:년령≥18세,재급진ICU존활시간≥24 h,부합2001년화성돈“국제농독증정의회의”추천적엄중농독증진단표준、장기손상표준,역삼조해회의제정적표준,불부합상술입선표준적여이배제.재입선시간단내중복재ICU치료적환자취제일차입원적수거.수집소유입선병례적성명、년령、성별、기왕병사.제1천생명체정、혈상규、혈기、생화、응혈사항、뇨량.근거24 h내최차적수거진행APACHEⅡ、SOFA、SAPSⅢ、SAPS-3PIRO、MEDS평분.이환자28 d전귀정황위종점,기록존활화사망례수.사용SPSS 13.0통계연건분석수거,정태분포적계량자료균채용균수±표준차(-x±s)표시.생존조여사망조간,정태분포、방차제적계량자료채용독립양본f검험,방차불제채용t'검험,계수자료채용x2검험.안환자사망혹생존,진행이분류Logistic회귀분석,건립회귀방정;채용수시자공작특정곡선(ROC곡선)평개평분계통,대예후적판정능력병학정예후적계치,ROC곡선하면적(AUG)비교용Z검험.이P＜0.05위차이구유통계학의의.결과 APACHEⅡ、SOFA、SAPSⅢ、SAPS 3-PIRO화MEDS평분,시입선엄중농독증환자28 d사망적독립예측인소.통과SAPS 3-PIRO、APACHEⅡ、SOFA、SAPSⅢ화MEDS평분적ROC곡선급AUC비교:SAPS 3-PIRO평분여APACHEⅡ、SOFA화SAPSⅢ평분,예측예후적능력상당,MEDS평분예측예후적능력우우SAPS 3-PIRO、APACHEⅡ、SOFA화SAPSⅢ평분.결론 (1) MEDS평분예측예후적능력우우SAPS 3-PIRO、APACHEⅡ、SOFA화SAPSⅢ평분,MEDS구유량호적예측28 d사망적능력,MEDS≥11분시차류환자병사솔증가적표지.(2) SAPS 3-PIRO여APACHEⅡ、SOFA화SAPSⅢ평분예측능력상당,야가용우대급진ICU엄중농독증환자적예후진행예측.
Objective To investigate the feasibility of SAPS 3-PIRO score for prediction of outcomes in severe sepsis patients in the intensive care units (ICU).The optimal scoring system was also evaluated in this study.Methods Data of 677 patients with sepsis,treated in ICU of the emergency department at the Beijing Chaoyang Hospital between January 2008 and December 2011,were analyzed.The inclusion criteria were:age ≥18 years and the diagnostic criteria of severe sepsis and organ damage recommended by the International Sepsis Definitions Conference in Washington DC,USA in 2001,as well as the criteria developed by the Conference as a reference.The patients,who did not meet the criteria were excluded from the study.Age,gender,underlying disease,main infection site,and duration of ventilator support of all cases were recorded.Vital signs,hematological findings (gases,biochemistry,coagulation) and causative pathogens and organ damage on day-1 in the ICU were also recorded.According to the data of the most unfavorable findings in the ICU on day-1,scores got from APACHE Ⅱ,SOFA (sequential organ failure assessment),SAPS Ⅲ(simplified acute physiological score Ⅲ),SAPS 3-PIRO (predisposition,infection,response,organ failure/dysfunction) and MEDS (mortality in emergency department sepsis score) scoring systems were calculated.All patients were followed up for 28 days.The outcome of survival and death at 28 days were the endpoints of this study.SPSS V13.0 (SPSS,Chicago,IL,USA) was used to analyze data.Continuous variables with normal distribution were expressed as mean ± standard deviation.The independentsample t test was applied when normality (and homogeneity of variance) assumptions were fulfilled otherwise the t' test would be used.The distribution of categorical variables in two groups was tested using the x2 test.Binary logistic regression models were also used according to the survival status.The values of scoring system in predicting outcomes and the determination of dividing value in predicting death were analyzed using receiver operating characteristic (ROC) curves.The area under the receiver operating characteristic (AUROC) curves was compared using Z test.P values less than 0.05 were considered statistically significant.Results The total 28-day mortality was 41.9％.APACHE Ⅱ,SOFA,SAPS Ⅲ,SAPS 3-PIRO and MEDS scoring systems were used to find the independent predictive factors of death within 28 hours in patients with severe sepsis.By using ROC curve and AUROC curve to compare the validity of these scoring systems,SAPS 3-PIRO score had comparable predictive capability in comparison with APACHE Ⅱ,SOFA and SAPS Ⅲ scores,and MEDS was superior to SAPS 3-PIRO,APACHE Ⅱ,SOFA and SAPS Ⅲ score.Conclusions For patients with severe sepsis admitted in ICU,MEDS was superior to SAPS 3-PIRO,APACHE Ⅱ,SOFA and SAPS Ⅲ score in predicting prognosis.MEDS has favorable capability in predicting death within 28 days.MEDS ≥ 11 was the sign of increased mortality.SAPS 3-PIRO score has comparable predictive capability in comparison with APACHE Ⅱ,SOFA and SAPS Ⅲ score and it may be suggested for clinical practice.
