老年脓毒症患者急性胃肠损伤与疾病严重程度和预后的关系  

Association between acute gastrointestinal injury grading system and disease severity and prognosis in elderly patients with sepsis

作　　者：王玲玲[1] 陈蕊[1] 莫泽珣[1] 董家辉[1] 孙照琨[1] 肖飞[1] 胡少婷[1] 熊日成[1] 孙杰[1] 俞宙[1] 郭振辉[1] 

机构地区：[1]广州军区广州总医院老年重症医学科广东省老年感染与器官功能支持重点实验室广州市老年感染与脏器功能支持重点实验室,广东广州510010

出　　处：《中国急救医学》2017年第5期397-400,共4页Chinese Journal of Critical Care Medicine

基　　金：广东省科技计划项目（2012A061400010）;广东省广州市科研条件建设项目（7411675081103）;广州市科技计划项目科学研究专项（2014J4100033）

摘　　要：目的探讨急性胃肠损伤（AGI）分级在老年脓毒症患者的可行性与有效性。方法回顾性分析2014—03～2015—12广州军区广州总医院MICU连续收治的住院时间〉2d的老年脓毒症患者。统计所有患者的年龄、性别、人科当天的急性生理学与慢性健康状况（APACHE）Ⅱ评分、序贯性器官衰竭评价（SOFA）评分、AGI分级（AGIinitial）、1周内最高AGI分级（AGImax）、机械通气与连续性血液滤过的比例、ICU住院时间。记录28d病死率与90d病死率。比较不同AGI分级间各项目的差异。结果共纳入患者91例。AGIinitialⅠ级、Ⅱ级、Ⅲ级SOFA评分分别为（9．7±3．1）分、（11．3±3．7）分、（13．6±3．7）分，各组间的差异具有统计学意义（P〈0．05）。AGImaxⅠ级、Ⅱ级、Ⅲ＋Ⅳ级SOFA评分分别为（8．9±3．4）分、（10．6±3．5）分和（12．1±3．6）分，各组间的差异具有统计学意义（P〈0．05）。AGIinitialI级、Ⅱ级、Ⅲ级28d病死率分别为13．2％、46．2％及78．6％，90d病死率分别为23．7％、71．8％及85．7％。AGImaxI级、Ⅱ级、Ⅲ＋Ⅳ级28d病死率分别为0、22．5％和65．8％，90d病死率分别为15．4％、45．0％和76．3％。AGI分级越高，病死率越高（P〈0．05）。结论AGI分级系统可以反映老年脓毒症患者的疾病严重程度，区分患者的预后。Objective To assess the feasibility and effectiveness of acute gastrointestinal injury grade （AGI） in elderly patients with sepsis. Methods Elderly patients with sepsis admitted to our ICU between March 2014 and December 2015 and staying for critical care 〉 2 days were enrolled. Age, gender, APACHE Ⅱ score, SOFA score and AGI grade（ACIinitial） at admission, the highest AGI grade （AGImax ） within the first week, length of ICU stay, usage of mechanical ventilation and renal replacement therapy, 28 - day mortality and 90 - day mortality were recorded. Variables were compared among the AGI grades. Results 91patients were enrolled. There was a significantly difference of SOFA score among AGIinitial grade Ⅰ , Ⅱ and ill （P〈0. 05） ： the scores were 9.7 ±3.1,11.3 ±3.7,13.6 ± 3.7, respectively. SOFA score in AGI grade Ⅰ , Ⅱ and Ⅲ＋ Ⅳ also shown significantly difference with the score of 8.9 ± 3.4, 10.6 ±3.5, 12.1 ±3.6, respectively （ P 〈 0.05 ）. For patients classified as AGIinitial grade Ⅰ , Ⅱ and m, the 28 - day mortality rates were 13.2% ,46.2% and 78.6% , while the 90 - day mortality rates were 23.7% ,71.8% ,85.7%. For patients classified as AG1 grade Ⅰ , Ⅱ and Ⅲ ＋ Ⅳ, the 28 - day mortality rates were 0.0% , 22.5% and 65.8% , respectively, and the 90 - day mortality rates were 15.4%, 45.0% and 76.3%. The higher AGI grade was, the higher mortality of patients could be. Conclusion The current AGI grade system is associated with disease severity in elderly patients with sepsis, and can provide a preliminary assessment regarding the prognosis for patients.

关 键 词：急性胃肠损伤(AGI) 老年 脓毒症 

分 类 号：R572[医药卫生—消化系统]