重症医学常用评分系统与降钙素原在评估严重多发伤中的价值

Value of critical care medicine scoring systems and procalcitonin in evaluation of severe multiple trauma

目的比较急性生理和慢性健康评估Ⅱ（acutephysiologyandchronichealthevalua·tion11，APACHEⅡ）评分、序贯性器官衰竭评估（sequentialorganfailureassessment，SOFA）评分与降钙素原（procalcitonin，PCT）在评估严重多发伤中的价值。方法回顾性分析2010年7月1日-2011年10月31日收治的严重多发伤患者的临床资料。对严重多发伤患者24h内常规进行PCT检测及APECHEII评分、SOFA评分，对1周内发生脓毒症的严重多发伤患者1周时再次进行PCT检测及APECHEⅡ评分、SOFA评分。结果对发生脓毒症的严重多发伤患者，APACHEⅡ评分、SOFA评分在感染性休克组高于严重脓毒症组和脓毒症组（P〈0．01），PCT在脓毒症组、严重脓毒症组、感染性休克组差异无统计学意义（P〉0．05）。人院APECHEⅡ评分、SOFA评分、PCT在预测严重多发伤患者出现脓毒症的接受者操作特性曲线（receiveroperatingcharacteristiccurve，ROC）的曲线下面积（areasunderthecurve，AUC）分别为0．615，0．663，0．160，入院APECHEⅡ评分、SOFA评分、PCT在预测严重多发伤发生死亡的ROC的AUC分别为0．576，0．571，0．619。1周时APECHEⅡ评分、SOFA评分、PCT在预测严重多发伤脓毒症患者发生死亡的ROC的AUC分别为0．746，0．837，0．600。结论APECHEⅡ评分和SOFA评分评估严重多发伤脓毒症的感染严重程度优于PCT，SOFA评分预测严重多发伤发生脓毒症的效果最好，PCT最差。PCT预测严重多发伤发生死亡的效果最好，SOFA评分最差。SOFA评分预测严重多发伤脓毒症患者发生死亡的准确性优于APECHEU评分和PCT。

Objective To compare the value of acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） , sequential organ failure assessment （SOFA） and procalcitonin （PCT） in assessment of severe multiple trauma. Methods A retrospective study was carried out on clinical data of patients with severe multiple trauma who were admitted to ICU from July 1st 2010 to October 31st 2011. PCT de- tection, APECHE Ⅱand SOFA scoring were routinely performed for all the patients within 24 hours, and were performed again one week later for the patients who were complicated with sepsis within one week. Results The score of APACHE Ⅱ and SOFA in septic shock group was higher than that in severe septic and septic groups （ P 〈 0.01 ）, while PCT level among septic, severe septic and septic shock groups had no statistical difference （P 〉 0.05）. To determine the predicting accuracy of APECHE Ⅱ score, SOFA score and PCT, receiver operating characteristic curve （ROC） was constructed. The areas under the curve （AUC） for APECHE Ⅱ score, SOFA score and PCT in predicting the emergence of sepsis on admis- sion was 0. 615, 0.663 and 0. 160 respectively. AUC for APECHE Ⅱ score, SOFA score and PCT in predic ting the occurrence of death among the severe multiple trauma patients on admission was 0.576, 0.571 and0. 619 respectively. AUC for APECHEⅡ , SOFA and PCT in predicting the death of patients complicated with sepsis at one week after admission was 0. 746, 0. 837 and 0. 600 respectively. Conclusions Among the APACHE Ⅱ score, SOFA score and PCT, APACHEⅡ and SOFA score are better than PCT in assessing the infection severity of sepsis. SOFA score is the best in predicting the occurrence of sepsis, while PCT is the worst. PCT is the best in predicting the occurrence of death of severe multiple trauma pa- tients, while SOFA score is the worst. SOFA score is better than APACHE Ⅱ score and PCT in predicting the occurrence of death of the patients complicated with sepsis.