危重病评分在急诊室急性肾损伤患者病情及预后评估中的应用价值  

Evaluation of critical illness score in patients with acute kidney injury and prognosis in emergency department

作　　者：陶晓阳 樊雨良 王美雯[1] 刘沁[1] 王一波[1] 富秀英 李花[1] 施方人 

机构地区：[1]上海市黄浦区中心医院肾内科,200002

出　　处：《疑难病杂志》2016年第6期592-594,共3页Chinese Journal of Difficult and Complicated Cases

基　　金：上海市黄浦区优秀青年人才培养计划配套课题

摘　　要：目的研究危重病评分在急诊室急性肾损伤(AKI)患者病情及预后评估中的应用价值。方法选取2014年1—12月上海市黄浦区中心医院急诊观察室收治的AKI患者59例为研究对象,按病情分为危险亚组(n=15)、损伤亚组(n=27)、衰竭亚组(n=17);又按照28 d内存活情况分为存活亚组(n=39)和死亡亚组(n=20)。比较各组患者血肌酐(SCr)、尿量,并分别进行急性生理学与慢性健康状况评分(APACHE)Ⅱ、序贯性脏器衰竭评分(SOFA)、简化急性生理学评分(SAPS)Ⅱ,记录患者28 d的存活情况,采用Logistic回归分析28 d内预后的危险因素。结果随着病情的加重,AⅪ患者APACHEⅡ、SOFA、SAPSⅡ评分、病死率显著升高,衰竭亚组>损伤亚组>危险亚组(P<0.05);死亡亚组患者年龄明显大于存活亚组,且SCr、APACHEⅡ、SOFA、SAPSⅡ评分均明显高于存活亚组(P<0.05),尿量明显低于存活亚组(P<0.05);多因素Logistic回归分析显示,AKI分期、APACHEⅡ、SOFA、SAPSⅡ评分均是AⅪ患者28 d内死亡的独立危险因素(P<0.05)。结论 APACHEⅡ、SOFA、SAPSⅡ评分均可作为急诊室AKI患者病情危险分层及预后评估的重要指标。Objective To explore the evaluation value of severity scoring systems in the prognosis and condition evaluation of acute kidney injury（AKI） in emergency ward.Methods Fifty-nine cases of patients with AKI were received in emergency ward of Central Hospital of Shanghai Huangpu District from January to December 2014,the level of SCr and urine volume among different groups were assessed,all the eases were evaluated by APACHE Ⅱ,SOFA,SAPS Ⅱ.and survival condition within 28 days was recorded,risk factors ol mortality within 28 days were analyzed by logistic regression analysis.Results With the severity of sepsis,the APACHE Ⅱ,SOFA,SAPS Ⅱ,mortality were significantly increased（P〈0.05）.The age in death group was older than that in survival group,and SCr,APACHE Ⅱ,SOFA,SAPS Ⅱ scores were significantly higher than the survival group（P〈0.05）,the urine was significantly lower than the survival group（P〈0.05）.Multiple logistic regression analysis showed APACHE Ⅱ,SOFA,SAPS Ⅱ and stage of AKI were all independent risk factors of mortality within 28 days（P〈0.05）.Conclusion The severity scoring systems including APACHE Ⅱ,SOFA,SAPS Ⅱ can be served as important indicators in the evaluation of risk stratification and prognosis for AKI patients in emergency ward.

关 键 词：危重病评分 肾损伤 急性 急诊室 预后评估 

分 类 号：R459.7[医药卫生—急诊医学]