影响急诊危重症病人预后的危险因素分析

doi:10.3969/j.issn.1006-7795.2017.04.021

摘要/Abstract

摘要： 目的探讨临床生物学指标及评分系统对急诊抢救室危重症病人28 d死亡的预测能力，为临床提供可靠的危重症评估方法。方法对2014年1月至2015年5月在首都医科大学附属北京朝阳医院急诊科抢救室救治的所有内科病人进行前瞻性研究，记录病人28 d预后。入院24 h内监测生命体征、生化全项、凝血功能、动脉血气分析、乳酸、C反应蛋白等化验室指标，行急性生理与慢性健康评分Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ评分）、简化急性生理学评分Ⅱ（simplified acute physiology score Ⅱ，SAPS Ⅱ评分）、序贯器官衰竭评分（sepsis-related organ failure assessment，SOFA评分）及急诊脓毒症死亡风险评分（mortality in emergency department sepsis，MEDS评分）。结果纳入研究的病人2 089例，按28 d预后分为生存组（n=1 617）与死亡组（n=472）。两组病人年龄、性别、体质量指数及疾病种类等基础情况差异无统计学意义（P>0.05）。生存组与死亡组APACHE Ⅱ、SAPS Ⅱ、SOFA及MEDS评分分别为11.64±4.33 vs 20.87±5.46； 25.23±8.67 vs 42.96±12.97； 6.28±4.54 vs 10.98±5.89； 1.86±1.80 vs 4.90±3.97，两组间差异有统计学意义（P<0.001）。死亡组C反应蛋白及乳酸显著升高，与生存组相比，差异具有统计学意义（P<0.001）。Logistic回归证实高血乳酸、APACHE Ⅱ、MEDS及SAPS Ⅱ评分为危重症病人预后不良的危险因素。受试者工作特征曲线（receiver operating characteristic curve，ROC曲线）亦证实APACHE Ⅱ评分判断预后效果最佳，其灵敏度和特异度分别为88.38%和82.93%。结论 4种评分系统中，APACHE Ⅱ评分对急诊抢救室危重症病人28 d预后预测价值最高，生物学指标——血乳酸可作为急诊抢救室危重症病人28 d预后的独立危险因素。

关键词: 评分系统, 生物学指标, 急诊, 危重症, 预后

Abstract: Objective To investigated the biological indicators and evaluation scales of critically ill patients for predicting the prognosis of 28-day in a university hospital emergency room. Methods A prospective investigation was done in the emergency room of Beijing Chao-Yang Hospital, Capital Medical University from January 2014 to May 2015, and 28-day mortality was recorded. Monitor vital signs, blood biochemical, coagulation, arterial blood gas analysis, lactic acid, C-reactive protein and other laboratory indicators in admission of 24 hours. Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), simplified acute physiology score Ⅱ (SAPS Ⅱ), sepsis-related organ failure assessment system (SOFA) and the mortality in emergency department sepsis (MEDS) score were evaluated. Results A total of 2 089 patients were involved in, and were divided into two groups by 28-day prognosis: survival (n=1617) and dead (n=472). No significant difference of age, gender, body mass index and disease composition were found between the two groups(P>0.05). APACHEⅡ、SAPSⅡ、SOFA and MEDS scores of the survival and dead groups were 11.64±4.33 vs 20.87±5.46, 25.23±8.67 vs 42.96±12.97, 6.28±4.54 vs 10.98±5.89 and 1.86±1.80 vs 4.90±3.97 respectively, significant differences were found between the two groups (P<0.001).C-reactive protein and lactic acid were increased significantly (P<0.001 vs the survival group. The risk factors of poor prognosis, which were increased APACHE Ⅱ, MEDS, SAPS Ⅱ and lactic acid, were confirmed by Logistic analysis. The predicting power of APACHE Ⅱ was confirmed by ROC curve further; the sensibility and specificity were 88.38% and 82.93% respectively. Conclusion In the four scoring systems, the APACHE Ⅱ score was the most predictor of the 28-day prognosis in critically ill patients, and the biologic index of blood lactic acid could be used as an independent risk factor for the 28-day prognosis of critically ill patients.

Key words: scoring systems, biological indicators, emergency, critically ill, prognosis

中图分类号:

R459.7

王涛, 王烁, 唐子人, 李春盛. 影响急诊危重症病人预后的危险因素分析[J]. 首都医科大学学报, 2017, 38(4): 597-603.

Wang Tao, Wang Shuo, Tang Ziren, Li Chunsheng. Analysis of risk factors about the prognosis in the critically ill patients of emergency room[J]. Journal of Capital Medical University, 2017, 38(4): 597-603.

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