动态监测序贯器官衰竭估计评分在危重病患者预后评估中的应用价值

Value of Dynamic Monitoring SOFA Score in Critically Ill Patients

目的探讨动态监测序贯器官衰竭估计(SOFA)评分在危重病患者预后评估中的应用价值。方法选取本院重症科2010年5月—2011年9月收治的危重病患者84例为研究对象,4周内存活60例(存活组),死亡24例(死亡组)。分别于患者入ICU后第1、3、5、7天进行急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)和SOFA评分,比较两组不同时间APACHEⅡ和SOFA评分,分析器官损伤数与病死率及最大SOFA评分的关系及两组受损器官数和最大SOFA评分的差异。采用SPSS 13.0统计软件进行数据处理,计量资料采用t检验和方差分析,计数资料采用χ2检验。结果存活组患者入住ICU内1、3、5、7 d APACHEⅡ和SOFA评分与死亡组比较,差异均有统计学意义(P=0.00)。存活组患者入住ICU内1、3、5、7 d APACHEⅡ评分比较,差异有统计学意义(F=14.76,P=0.00);其中入住ICU内3、5、7 d与1 d时比较,差异均有统计学意义(q值分别为5.95、7.84和8.39,P=0.00)。死亡组患者入住ICU内1、3、5、7 d APACHEⅡ评分比较,差异无统计学意义(F=0.15,P=0.93)。存活组患者入住ICU内1、3、5、7 d SOFA评分比较,差异有统计学意义(F=18.27,P=0.00);其中入住ICU内3、5、7 d与1 d时比较,差异均有统计学意义(q值分别为5.04、8.06和9.74,P=0.00)。死亡组患者入住ICU内1、3、5、7 d SOFA评分比较,差异有统计学意义(F=5.35,P=0.00);其中入住ICU内5、7 d与1 d时比较,差异均有统计学意义(q值分别为2.98和5.03,P=0.00)。以受损器官3个为界,分为受损器官≥3个组和受损器官<3个组。受损器官≥3个组65例,死亡24例,病死率为36.92%;受损器官<3个组19例,无死亡患者,差异有统计学意义(χ2=9.82,P=0.00)。受损器官≥3个组存活患者最大SOFA评分为(7.73±2.23)分,死亡患者最大SOFA评分为(12.70±2.82)分,差异有统计学意义(t=-7.85,P=0.00);受损器官<3个组患者最大SOFA评分为(4.63±1.30)分。存活组和死亡组患者平均器官损伤数比较,差异有统计学意义(t=-6.65,P<0.05);两组SOFA评分中心血管、肾脏评分比较,差异均有统计学意义(P<0.05);两组SOFA评分中呼吸、凝血功能、肝脏、神经评分比较,差异均无统计学意义(P>0.05)。结论动态监测SOFA评分能更好地反映危重病患者器官损伤程度及治疗效果,有利于早期重点治疗方向的制定。

Objective To investigate the value of dynamic monitoring sequential organ failure assessment （SOFA） score in predicting outcome of critical ill patients. Methods Eighty - four critically ill patients admitted to ICU from May 2010 to September 2011 were divided into groups survival （n = 60, survived within 4 weeks）, death （n = 24）. Acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ） and SOFA score were performed on days 1, 3, 5, 7 after admission to ICU, to ana- lyze the relationship of number of damaged organs to mortality, maximum SOFA score. Results There was significant difference between 2 groups in APACHE II and SOFA on days 1, 3, 5, 7 after admission to ICU （P = 0. 00）. In survival group, there was difference in APACHE Ⅱ between days 1, 3, 5, 7 （F = 14. 76, P = 0.00）, and between days 3, 5, 7 and day 1 （q = 5.95, 7. 84, 8. 39, respectively, P=0. 00）. In death group, no difference was noted in APACHE Ⅱ between days 1, 3, 5, 7 （ F = 0. 15, P = 0. 93）. In survival group, there was difference in SOFA between days 1, 3, 5, 7 （F = 18. 27, P = 0. 00）, and between days 3, 5, 7 and day 1 （q = 5.04, 8. 06, 9. 74, respectively, P = 0. 00）. In death group, there was difference in SOFA between daysl, 3, 5, 7 （F=5.35, P=0.00）, and between days 3, 5, 7 and dayl （q=2.98, 5.03, respectively, P = 0. 00）. Twenty - four of t〉 3 - damaged - organ group （ n = 65） died （36. 92% ）, no patients died in 〈 3 - dam- aged - organ group （ n = 19）, the difference was significant （ x2 = 9.82, P = 0.00）. In ≥ 3 - damaged - organ group, the maximum SOFA of survival patients was （7. 73 ± 2. 23）, that of death （ 12. 70 ± 2. 82）, the difference was significant （ t = -7. 85, P = 0. 00） ; in 〈 3 - damaged - organ group, maximum SOFA was （4. 63 ± 1.30）. There was difference in average damaged organ number between groups survival and death （ P 〈 0.05 ）, and in scores of cardiovascular and kidney in SOFA （ P 〈 0. 05）, but there was not in scores of respiration, blood coagulation, liver, nerve （ P 〉 0. 05 ）. Conclusion Dynamic monito- ring SOFA, reflecting better the degree of organ damage and therapeutic effects in critically ill patients, is conductive to formula- tion of early treatment direction.