不同评分标准诊断DIC对脓毒症患者预后评估意义分析

Evaluation of Prognosis in Patients with Sepsis by Different Scoring Criteria to diagnose DIC

目的研究不同评分标准诊断弥散性血管内凝血(DIC)对脓毒症预后评估意义分析。方法按标准选取2015年3月至2017年3月在重症监护室接受治疗的患者102例,记录所有患者入院第1、3、7天的生理和实验室指标,分别使用SOFA,ISTH显性标准,ISTH非显性标准和JAAM标准评分,观察28d病死率及MODS的发生率。结果 102名患者中,符合ISTH显性标准的DIC患者13例(确诊率12.7%);符合JAAM标准的DIC患者34例(确诊率33.3%);符合ISTH非显性标准的DIC患者63例(确诊率61.8%)。ISTH显性标准确诊的13例患者均被其他两种标准提前或同时确诊。三种评分DIC组的28d病死率、最大SAFA评分均高于非DIC组,差异有统计学意义(P<0.05);与ISTH显性标准比较,ISTH非显性标准DIC病死率明显降低,差异有统计学意义(P<0.05);ISTH非显性标准的最大SOFA评分明显低于ISTH显性标准,差异有统计学意义(P<0.05)。结论对于脓毒症患者的初筛应选择ISTH非显性标准,而对于MODS的发生和预后则应以ISTH显性标准的结果为准。

Objective Analysis of the significance of DIC evaluation of the prognosis of sepsis by different scoring criteria.Methods According to the standard selected in March 2015 ～March 2017 in the intensive care unit in 102 patients treated.The physiological and laboratory indicators of all patients were recorded on the 1 st,3 rd and 7 th day of hospitalization.SOFA,ISTH dominant criteria,ISTH non-dominant criteria and JAAM criteria were used to observe the incidence of 28 days and MODS Occurred to SOFA score to reflect the results of statistical analysis.Results Among the 102 patients,13 patients（12.7%）were eligible for DIC in accordance with ISTH criteria.Thirty-three patients with DIC were enrolled in the JAAM standard（33.3%）.63 patients with DIC were eligible for ISTH Rate of 61.8%）.ISTH markedly identified 13 patients were confirmed by the other two criteria in advance or at the same time.The 28-day mortality and maximal SAFA scores of the three groups were significantly higher than those of the non-DIC group（P〈0.05）,compared with ISTH dominant standard,ISTH non-dominant standard DIC mortality was significantly lower,the difference was statistically significant（P〈0.05）;ISTH non-dominant standard maximum SOFA score was significantly lower than ISTH dominant standard,the difference was statistically（P〈0.05）.Conclusion For the sepsis patients should be selected ISTH non-dominant standard,and for the occurrence and prognosis of patients with MODS should be based on the results of ISTH dominant criteria.