EICU脓毒血症患者预后评估及相关因素

Analyses of related factors and prediction of outcome in emergency intensive care patients with sepsis

目的:采用急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)和序贯器官衰竭评估(SOFA)评估急诊ICU(EICU)脓毒血症患者的预后及危险因素分析。方法:回顾性分析2014年1月至2015年10月EICU住院的脓毒血症患者共83例,其中脓毒血症组(30例)和脓毒性休克组(53例),从临床病例资料收集PCT、PT、APTT、乳酸、机械通气时间,并进行APACHEⅡ和SOFA评分及相关分析,通过受试者工作特征曲线(ROC)预测脓毒血症患者预后。结果:脓毒性休克组患者的病死率、PT、APTT、APACHEⅡ、SOFA评分、机械通气时间和PCT明显高于脓毒血症组(P<0.001);存活组和病死组比较,APTT、APACHEⅡ、SOFA评分和机械通气时间差异有统计学意义(P≤0.001);病死组的乳酸水平明显高于存活组(P=0.038);APACHEⅡ评分的曲线下面积(AUC=0.806)大于SOFA评分(AUC=0.765)。相关分析脓毒血症的结局与APACHEⅡ、SOFA评分、乳酸和机械通气时间相关(P<0.05)。结论:APACHEⅡ评分是评估急诊EICU脓毒血症患者预后的理想指标,通过检测脓毒血症患者的凝血功能、APACHEⅡ、SOFA评分、PCT、乳酸和机械通气时间有助于评估病情及预后。

Objective To perform APACHE Ⅱ and SOFA in assessmentof EICU patients with sepsis, and analyze the risk factors. Methods A retrospective analysis from January 2014 to October 2015 in EICU of our hospital , a total of 83 patients suffered from sepsis, including sepsis group （30 cases） and septic shock （53 cases） . PCT, PT, APTT, lactic acid, mechanical ventilation time and APACHE Ⅱ and SOFA score were collected, through the receiver-operating characteristic curve （ROC） index to predict the prognosis of patients with sepsis.Re- suits The mortality of the patients in the septic shock group, PT, APTT,APACHE Ⅱ , SOFA score, mechanical ventilation time and PCT were significantly higher than thosein the sepsis group （P 〈 0.001 ）. APTT, APACHE Ⅱ , SOFA score and mechanical ventilation time had significant difference （P 〈 0.001 ） between survival and dead. The lactic acid level of the dead group was significantly higher than that in the survival group （P = 0.038）. The area under curve （AUC = 0.806） of APACHE Ⅱ score was better than the SOFA score （AUC -= 0.765 ）.The outcome of sepsis had correlation with APACHE Ⅱ , SOFA score, lactic acid, and mechanical ventilation time （P 〈 0.05）. Conclusion APACHE Ⅱ and SOFA scores can accurately predict mortalityoutcome in emergency intensive care units patients with sepsis, especially the APACHE Ⅱ score.We can measure blood coagulation function, APACHE Ⅱ , SOFA score, PCT, lactic acid and mechanical ventilation time to assess the severity of patients with sepsis.