CAJ | 학술논문

目的：探讨急诊脓毒症死亡风险评分（ MEDS）对脓毒症患者危险分层及预后的应用价值。方法选取2012年1月—2014年6月收治的脓毒症患者62例，根据入院时患者病情分为脓毒症组21例，严重脓毒症组24例，脓毒性休克组17例；根据28 d生存情况分为存活组41例，死亡组21例。对各组分别进行急性生理和慢性健康状况评分（ APACHE II）评分、序贯器官功能衰竭（ SOFA）评分、MEDS评分，并测定血乳酸水平，记录患者28 d的存活情况，采用Logistic回归分析28 d病死率的危险因素。结果严重脓毒症组和脓毒性休克组SOFA、血乳酸显著高于脓毒症组（ P ＜0怂．05），而严重脓毒症组与脓毒性休克组比较差异无统计学意义（ P ＞0．05）；APACHE II、MEDS评分：脓毒症组＜严重脓毒症组＜脓毒性休克组，差异均有统计学意义（ P ＜0．05）；严重脓毒症组与脓毒症组病死率均低于脓毒性休克组（ P ＜0．05）。死亡组患者年龄大于存活组，APACHE II评分、SOFA评分、MEDS评分及血乳酸水平均明显高于存活组（ P ＜0．05）；随着病情的加重，脓毒症患者MEDS评分、病死率显著升高（ P ＜0．05）；随着危险分层的增加，患者病死率也显著增高（ P ＜0．05）；多因素Logistic回归分析显示，APACHE II评分、SOFA评分、MEDS评分及血乳酸均是28 d病死率的独立危险因素（ P ＜0．05）。结论 MEDS评分的实用性优于APACHE II、SOFA评分，可作为脓毒症患者病情危险分层及预后评估的重要指标。
목적：탐토급진농독증사망풍험평분（ MEDS）대농독증환자위험분층급예후적응용개치。방법선취2012년1월—2014년6월수치적농독증환자62례，근거입원시환자병정분위농독증조21례，엄중농독증조24례，농독성휴극조17례；근거28 d생존정황분위존활조41례，사망조21례。대각조분별진행급성생리화만성건강상황평분（ APACHE II）평분、서관기관공능쇠갈（ SOFA）평분、MEDS평분，병측정혈유산수평，기록환자28 d적존활정황，채용Logistic회귀분석28 d병사솔적위험인소。결과엄중농독증조화농독성휴극조SOFA、혈유산현저고우농독증조（ P ＜0종．05），이엄중농독증조여농독성휴극조비교차이무통계학의의（ P ＞0．05）；APACHE II、MEDS평분：농독증조＜엄중농독증조＜농독성휴극조，차이균유통계학의의（ P ＜0．05）；엄중농독증조여농독증조병사솔균저우농독성휴극조（ P ＜0．05）。사망조환자년령대우존활조，APACHE II평분、SOFA평분、MEDS평분급혈유산수평균명현고우존활조（ P ＜0．05）；수착병정적가중，농독증환자MEDS평분、병사솔현저승고（ P ＜0．05）；수착위험분층적증가，환자병사솔야현저증고（ P ＜0．05）；다인소Logistic회귀분석현시，APACHE II평분、SOFA평분、MEDS평분급혈유산균시28 d병사솔적독립위험인소（ P ＜0．05）。결론 MEDS평분적실용성우우APACHE II、SOFA평분，가작위농독증환자병정위험분층급예후평고적중요지표。
Objective To explore the application value of mortality in emergency department sepsis ( MEDS) score for the risk stratification and prognosis of patients with sepsis.Methods Selected 62 cases of patients with sepsis admitted to our hospital from January 2012 to June 2014, according to hospitalized patients'condition, they were divided into sepsis group ( n =21),serious sepsis group ( n =24), septic shock group ( n =17);according to the 28 day survival, they were divid-ed into survival group ( n =41 ) and death group ( n =21 ) .Acute physiology and chronic health status score ( APACHE II) , sequential organ failure ( SOFA) , MEDS score were evaluated, and blood lactate level were measured, and the survival rate of patients with 28 d were recorded.The risk factors of mortality of 28 d were analyzed by Logistic regression analysis.Re-sults Severe sepsis group and septic shock group's SOFA, blood lactic acid were significantly higher than that in sepsis group ( P <0.05) , the difference between the severe sepsis group and septic shock group had no statistical significance ( P >0.05);APACHE II,MEDS score:sepsis group <severe sepsis group <septic shock group, the differences were statistically significant ( P <0.05);severe sepsis group and sepsis group's mortality rate were lower than in septic shock group ( P <0.05).Death group patients were older than the survival group, APACHE II score, SOFA, MEDS scores and blood lactate level were significantly higher than those of the survival group ( P <0.05);with the aggravation of the disease, sepsis pa-tients'MEDS score, mortality rate was significantly higher ( P <0.05);with the increase in risk stratification, the mortality rate was significantly increased ( P <0.05).Multivariate Logistic regression analysis showed that, APACHE II score, SO-FA, MEDS score and blood lactic acid were independent risk factors for 28 day mortality rate ( P <0.05).Conclusion The practicability of MEDS score was better than that of APACHE II and SOFA score, which can be used as an important index in the risk stratification and prognosis of patients with sepsis.