3种评分量表对热射病预后评估的比较  

Three scales in predicting prognosis of patients with heat stroke

作　　者：李博志[1] 胡怀强[2] 程明[2] 张蕾[2] 曹秉振[2] 

机构地区：[1]第二军医大学研究生院,上海医学硕士200433 [2]济南军区总医院神经内科,山东250031

出　　处：《医学研究生学报》2016年第5期518-521,共4页Journal of Medical Postgraduates

基　　金：全军医学研究"十二五"课题(BWS11J062)

摘　　要：目的目前在热射病诊治中应用的评分量表一般为借鉴其他专科量表形成。尚未有针对热射病经大规模临床试验验证的评分系统。文中就常用的急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、弥漫性血管内凝血(dissolved inorganic carbon,DIC)评分、多器官衰竭(multiple organ dysfunction,MODS)评分对热射病患者预后的评估价值进行比较,以及对3种评分加和、3种评分除权加和对热射病患者预后的评估价值进行比较,探寻较高临床应用价值的评分方法。方法对43名收住神经科重症监护室以及重症监护室诊断为热射病的危重患者分别进行APACHEⅡ、MODS评分、DIC评分及3种评分加和、3种评分除权加和分析。对5种得分进行受试者工作曲线(ROC)下面积分析。结果 3种评分除权加和具有最大的ROC曲线下面积0.896;MODS评分最佳截断点处敏感度72.7%、特异度99.69%;DIC评分最佳截断点处敏感度100%、特异度56.2%;3种评分除权加和最佳截断点处敏感度72.7%、特异度100%。结论 APACHEⅡ、MODS评分、DIC评分以及3种评分加和、3种评分除权加和的方法均可较好预测热射病患者预后,但判断预后的价值仍有欠缺,临床上亟需开发一种针对性更强的评分系统。Objective The scale lists applied in the diagnosis and treatment of heat stroke generally draw on other specialty scales,and there is no specific scoring system on heat stroke verified by large-scale clinical trials. The paper compared common acute physiology and chronic health evaluation Ⅱ（ APACHE Ⅱ）,dissolved inorganic carbon score（ DIC score）,multiple organ dysfunction score（ MOD score） for the prognostic evaluation of heat stroke patients,the sum of three scores and the sum of the percentages of three scores to the score sum on prognostic evaluation of heat stroke patients in order to find a scoring method with higher clinical value.Methods APACHE Ⅱ,MOD score,DIC score,the sum of three scores and the sum of three scores were applied on 43 patients with heat stroke admitted in our neurological intensive care unit（ NICU） or in intensive care unit（ ICU）. The analysis of the area under the receiver operating characteristic（ ROC） curve（ AUC） analysis was made among five scores. Results The weighted sum of three scores has the largest AUC（ 0. 896） in predicting the death of HS patients according to AUC. The optimal MOD score was 5. 5 in predicting the death of HS with a sensitivity of 72. 7% and a specificity of 99. 69%. The optimal DIC score was 1. 5 in predicting the death of HS with a sensitivity of 100% and a specificity of 56. 2%. The optimal score of the sum of the percentages of three scores to the score sum was 0. 727 in predicting the death of HS with a sensitivity of72. 7% and a specificity of 100%. Conclusion All the five scores can predict the prognosis of patients with heat stroke. However,due to the deficiency in the prognosis value,a more specific scoring system needs to be developed.

关 键 词：热射病 APACHEⅡ MODS评分 DIC评分 

分 类 号：R594.1[医药卫生—内科学]