血乳酸、降钙素原及APACHEⅡ评分联合对脓毒症早期诊断及预后的评价  

Assessment of Early Diagnosis and Prognostic of Severe Trauma Sepsis Patients with Combination of Lac,Procalcitonin and APACHE Ⅱ Scores

作　　者：吴昆鹏[1] 陈莹[1] 李方[1] 言彩红[1] 黄治家[1] 桂培根[1] 

机构地区：[1]南华大学附属第二医院重症医学科,湖南衡阳421001

出　　处：《中南医学科学杂志》2015年第4期439-442,共4页Medical Science Journal of Central South China

摘　　要：目的评价血乳酸（Lac）、降钙素原（PCT）及APACHEⅡ评分联合监测对脓毒症患者诊断及预后的评估价值,探索评估脓毒症患者预后的有效指标。方法回顾分析入住ICU的严重创伤患者137例,检测血清Lac、PCT并行APACHEⅡ评分,用ROC曲线及生存分析法评估联合监测3项指标诊断脓毒症及预后的价值。结果 137例患者中脓毒症患者57例,脓毒症患者第1天血清Lac、PCT浓度及APACHEⅡ评分均较存非脓毒症患者升高（P〈0.05）。血清Lac、PCT及APACHEⅡ评分联合诊断脓毒症的ROC曲线下总面积分别为0.809（95%CI：0.738~0.881）、0.909（95%CI：0.859~0.959）、0.830（95%CI：0.760~0.900）,最佳临界值分别为4.25μmol/L、1.8 ng/m L、8.5分。制定联合评分后,2分及以上的曲线下面积为0.910（95%CI：0.853~0.967）,诊断脓毒症的敏感性为89.5%,特异性为92.5%。联合评分1~3分之间28天死亡率有明显差异（P〈0.05）。结论Lac、PCT及APACHEⅡ评分联合评分能有效的早期诊断脓毒症,并可有效评估预后。Objective To assess the value of combined determination of blood serum lactic acid（ Lac）,procalcitonin（ PCT） and APACHE Ⅱ grade point for the early diagnosis and prognostic assessment of sepsis in severe trauma patients. Methods The severe trauma patients admitted to ICU were enrolled. The levels of Lac,PCT and APACHE Ⅱscore were determined,and the ROC curve and survivor curve were plotted to analyze the diagnostic and prognostic value of the combined determination of three indicators. Results A total of 137 severe trauma patients were enrolled and 57 patients were demonstrated as sepsis. The serum Lac,PCT level and APACHE Ⅱ grade points of patients with sepsis were higher than patients without sepsis in the first day（ P〈0. 05）. The AUCROC of plasma Lac,PCT lever and APACHE Ⅱgrade points were 0. 809（ 95% CI： 0. 738 ~ 0. 881）,0. 909（ 95% CI： 0. 859 ~ 0. 959）,0. 830（ 95% CI： 0. 760 ~ 0. 900） and the cut off values were 4. 25μmol / L,1. 8ng / m L,8. 5 scores. The AUCROC with the Joint score of more than 2 was 0. 910（ 95% CI： 0. 853 ~ 0. 967）. The sensitivity of the diagnosis of sepsis was 89. 5%. Specificity was 92. 5%,the 28 day mortality between Joint score 1 ~ 3 score had obvious difference（ P〈0. 05）. Conclusion Combination of scores with Lac,PCT and APACHE Ⅱ score was effective for early diagnosis and prognostic assessment of sepsis.

关 键 词：乳酸 降钙素原 APACHEⅡ评分 脓毒症 

分 类 号：R631[医药卫生—外科学]