基于常规血液检测的腹部外科危重病评估模型探索

A evaluation model based on conventional blood parameters for the abdominal critically ill surgical patients

目的筛选9种腹外科危重病的血标本检查指标,建立数学模型与APACHEⅡ评分联合评估病人的病情及预后。方法收集206例外科危重病房APACHEⅡ评分≥6的危重病人的完整病历资料,计算其APACHEⅡ评分,对血常规,凝血功能,血脂,血气,电解质及CRP等检验指标进行回顾性分析,并以住院期间病人是否死亡评估预后,通过Logistic回归分析探讨各检验指标的临床意义。结果随APACHEⅡ评分的升高,TC、TG、LDL、PT、APTT、PLT、HCO3-、D-D、CRP、Lac和Alb差异具有统计学意义(P<0.05),其它指标未见明显差异;死亡组比存活组APACHEⅡ评分明显升高;Logistic回归分析表明pH、Lac、TC、PT、D-D、Alb的显著异常是预测病人死亡的独立因素(P<0.05)其logistic回归方程为:Y=-1.164+1.784PT+1.833D-D-1.439TC-1.773pH+1.957Lac-0.053Alb。结论 TC、PT、PH、Lac、Alb和D-D是评估腹部外科危重病人病情及预后的良好线性指标,可联合应用回归模型与APACHEⅡ评分系统综合评估病人病情与预后。

Objective Select abnormal parameters of blood samples caused by 9 types of abdominal surgical critically ill to establish mathematical model,combining with APACHEII score system to make assessment of the patient’s condition and prognosis.Methods 206 cases from surgical intensive care unit were enrolled（APACHEII score≥6）,whose complete clinical data was analyzed retrospectively.The APACHEII score was calculated.Routine blood test,blood coagulation,serum lipids,arterial blood gases analysis,electrolyte analysis,C-reactive protein and other laboratory parameters were retrospectively analyzed.Death during hospitalization was studied to access patients’ prognosis.Clinical significance of this laboratory parameters were analyzed by Logistic regression.Results With the increasing of APACHEII score,TC,TG,LDL,PT,APTT,PLT,HCO3-,D-D,CRP,Lac and Alb had significant difference（P〈0.05）,while the others had no significant statistical difference.The APACHEII score of death group had increased more significantly than living group.Logistic regression analysis showed the obvious abnormality of pH,Lac,TC,PT,D-D,Alb were independent factors to the death of SICU patient.The logistic regression equation was as follow：Y=-1.164＋1.784PT＋1.833D-D-1.439TC-1.773pH＋1.957Lac-0.053Alb.Conclusion TC,PT,pH value,Lac,Alb and D-D were good linear indicators to access SICU patients’condition and prognosis.Combine regression model with APACHEII score system was available for comprehensive assessment to patients.