改良早期预警评分联合血乳酸对老年严重脓毒症患者预后评估的临床研究  

Combination of MEWS Score and Blood Lactate Level as a Predictor of Mortality in Geriatric Patients with Severe Sepsis

作　　者：任小强[1] 沈奕[1] 庄智伟[1] 

机构地区：[1]苏州市立医院本部急诊内科,江苏苏州215002

出　　处：《中国血液流变学杂志》2016年第1期53-56,共4页Chinese Journal of Hemorheology

摘　　要：目的：探讨改良早期预警评分（MEWS）联合血乳酸对老年严重脓毒症患者预后的预测价值。方法采用回顾性研究方法，选择2012年9月—2015年6月急诊收治的102例老年严重脓毒症患者，进行MEWS评分、APACHE Ⅱ评分和动脉血乳酸测定，记录28 d转归情况。对生存组和死亡组进行比较，通过Logistic回归分析，应用受试者工作曲线比较各预测因子及MEWS评分联合血乳酸对预后的预测能力。结果102例严重脓毒症患者28 d死亡39例，病死率38.2%。与生存组相比，死亡组有较高的MEWS评分、APACHEⅡ评分、血乳酸水平（P＜0.05）。各预测因子预测患者28 d病死率的ROC曲线下面积（AUC）由高到低依次为APACHEⅡ评分（0.845）、MEWS评分（0.787）、血乳酸（0.733）。MEWS评分联合血乳酸对患者28 d病死率的预测能力（AUC为0.832）与APACHEⅡ评分相当（P＞0.05），优于MEWS评分和血乳酸（P＜0.05）。结论 MEWS评分联合血乳酸对于老年脓毒症患者有较好的预测价值。Objective To evaluate the combination of modiifed early warning score（MEWS）with blood lactate level in the risk stratiifcation of geriatric patients with severe sepsis.Methods A retrospective study was conducted. 102 geriatric patients with severe sepsis admitted from September 2012 to June 2015 in ED were found to be eligible for the study. MEWS score, acute physiology and chronic health evaluationⅡ （APACHEⅡ） score, and arterial blood lactate was determined, and the outcomes in 28 days were recorded. Comparison between survivors and non-survivors, Logistic regression analysis was used to evaluate the relationship between each predictive factor score and prognosis. Each predictive factor was compared with the areas under the receiver operating characteristics （ROC） curve （AUC）.Results The mortality in 28 days was 38.2% in 102 patients. Compared with survivors, the patients in non-survival group with higher MEWS score, APACHEⅡ score, and arterial blood lactate. The rank of AUC from high to low were MEWS score （0.845）, APACHEⅡ score （0.787）, and arterial blood lactate （0.733）. The AUC of MEWS score combined with lactate was 0.832, and 28-day mortality prediction was almost the same as APACHEⅡ score （P〉0.05）. The combined score in predictingthe prognosis was obviously better than that of MEWS score and lactate （P〈0.05）.ConclusionMEWS score combined with lactate is a useful method for risk stratiifcation in geriatric patients with severe sepsis.

关 键 词：改良早期预警评分 急性生理学与慢性健康状况Ⅱ评分 乳酸 老年病人 严重脓毒症 

分 类 号：R631[医药卫生—外科学]