急诊脓毒症死亡风险评分对脓毒症患者危险分层及预后的应用价值  

Emergency sepsis mortality in emergency department sepsis score value for patients with sepsis in risk stratification and prognosis

作　　者：戴晓勇[1] 华玮[1] 叶宥文[1] 周季兰[1] 沈健[1] 颜伶[1] 

机构地区：[1]同济大学附属杨浦医院急诊科,上海200090

出　　处：《疑难病杂志》2015年第11期1141-1143,共3页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨急诊脓毒症死亡风险评分(MEDS)对脓毒症患者危险分层及预后的应用价值。方法选取2012年1月—2014年6月收治的脓毒症患者62例,根据入院时患者病情分为脓毒症组21例,严重脓毒症组24例,脓毒性休克组17例;根据28 d生存情况分为存活组41例,死亡组21例。对各组分别进行急性生理和慢性健康状况评分(APACHE II)评分、序贯器官功能衰竭(SOFA)评分、MEDS评分,并测定血乳酸水平,记录患者28 d的存活情况,采用Logistic回归分析28 d病死率的危险因素。结果严重脓毒症组和脓毒性休克组SOFA、血乳酸显著高于脓毒症组(P<0.05),而严重脓毒症组与脓毒性休克组比较差异无统计学意义(P>0.05);APACHE II、MEDS评分:脓毒症组<严重脓毒症组<脓毒性休克组,差异均有统计学意义(P<0.05);严重脓毒症组与脓毒症组病死率均低于脓毒性休克组(P<0.05)。死亡组患者年龄大于存活组,APACHE II评分、SOFA评分、MEDS评分及血乳酸水平均明显高于存活组(P<0.05);随着病情的加重,脓毒症患者MEDS评分、病死率显著升高(P<0.05);随着危险分层的增加,患者病死率也显著增高(P<0.05);多凶素Logistic回归分析显示,APACHE II评分、SOFA评分、MEDS评分及血乳酸均是28 d病死率的独立危险因素(P<0.05)。结论 MEDS评分的实用性优于APACHE II、SOFA评分,可作为脓毒症患者病情危险分层及预后评估的重要指标。Objective To explore the application value of mortality in emergency department sepsis （MEDS） score for the risk stratification and prognosis of patients with sepsis. Methods Selected 62 cases of patients with sepsis admitted to our hospital from January 2012 to June 2014, according to hospitalized patients＇ condition, they were divided into sepsis group （ n = 21 ）, serious sepsis group （ n =24）, septic shock group （ n = 17 ） ; according to the 28 day survival, they were divided into survival group （ n =41 ） and death group （ n = 21 ）. Acute physiology and chronic health status score （APACHE II） , sequential organ failure （SOFA）, MEDS score were evaluated, and blood lactate level were measured, and the survival rate of patients with 28 d were recorded. The risk factors of mortality of 28 d were analyzed by Logistic regression analysis. Resuits Severe sepsis group and septic shock group＇s SOFA, blood lactic acid were significantly higher than that in sepsis group （ P 〈 0. 05 ）, the difference between the severe sepsis group and septic shock group had no statistical significance （ P 〉 0.05） ;APACHE II, MEDS score： sepsis group 〈 severe sepsis group 〈 septic shock group, the differences were statistically significant （ P 〈 0.05） ; severe sepsis group and sepsis＇ group＇s mortality rate were lower than in septic shock group （ P 〈 0.05）. Death group patients were older than the survival group, APACHE II score, SOFA, MEDS scores and blood lactate level were significantly higher than those of the survival group （ P 〈 0.05 ） ; with the aggravation of the disease, sepsis patients＇ MEDS score, mortality rate was signifieandy higher （ P 〈 0.05 ） ; with the increase in risk stratification, the mortality rate was significantly increased （ P 〈 0.05 ）. Multivariate Logistic regression analysis showed that, APACHE II score, SO- FA, MEDS score and blood lactic acid were independent risk factors for 28 day mortality rate （ P 〈 0.05 ）. Co

关 键 词：急诊脓毒症死亡风险评分 脓毒症 危险分层 预后 

分 类 号：R459.7[医药卫生—急诊医学]