qSOFA评分在灾害创伤患者早期脓毒症中的诊断效能  

Diagnostic efficacy of q SOFA score in patients with early sepsis after acute trauma

作　　者：胡盼[1] 刘蕾[2] 唐昊[3] 何海燕[2] 胡艳红[1] HU Pan;LIU Lei;TANG Hao;HE Haiyan;HU Yanhong(Department of Outpatient;Department of Nursing;Department of Intensive Care Unit, Institute of Field Surgery, Daping Hospital, The Third Military Medical University, Chinese People's Liberation Army, Chongqing 400042, China)

机构地区：[1]第三军医大学大坪医院野战外科研究所门诊部,重庆400042 [2]第三军医大学大坪医院野战外科研究所护理部,重庆400042 [3]第三军医大学大坪医院野战外科研究所重症监护室,重庆400042

出　　处：《中华灾害救援医学》2017年第5期251-254,共4页Chinese Journal of Disaster Medicine

摘　　要：目的探讨快速序贯器官功能评分(quick Sequential Organ Failure Assessment,q SOFA)在急诊创伤患者早期脓毒症筛查中的有效性。方法选取第三军医大某附属医院2016-08-01至2016-11-30收治的70例急诊创伤患者,采用q SOFA及全身炎性反应综合征(systemic inflammatory response syndrome,SIRS)评分方法筛查脓毒症,根据测评工具的不同将患者分为q SOFA组及SIRS组两组;以2012国际脓毒症指南标准作为诊断脓毒症的"金标准",计算其诊断灵敏度及特异度,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)。结果 70例创伤患者中,q SOFA组共计检出脓毒症46例,其中确诊31例,诊断灵敏度为80.56%,特异度为55.88%;SIRS组共计检出脓毒症47例,其中确诊29例,诊断灵敏度为80.56%,特异度为48.57%。q SOFA组和SIRS组ROC的曲线下面积(area under the curve,AUC)分别为0.71和0.64,曲线下面积比较,差异无统计学意义(P=0.276)。q SOFA组与SIRS组的总住院时间分别为(23.5±8.3)d、(30.1±14.3)d,差异具有统计学意义(P=0.002);q SOFA组与SIRS组的30 d病死率分别为6.5%和12.7%,差异无统计学意义(P=0.504)。结论 2种测评工具应用于急诊创伤患者脓毒症筛查诊断的准确性无差异,以q SOFA≥2作为急诊创伤患者早期脓毒症筛查工具值得推荐。Objective This study objective was to investigate the effectiveness of quick Sequential Organ Failure Assessment(qSOFA)in screening for early sepsis in patients following acute trauma.Methods A total sample of70patients with acute trauma presented to a hospital affiliated to the Third Military Medical University of PLA from1st August to the30th November2016were enrolled in this study.The qSOFA score and systemic inflammatory response syndrome(SIRS)were applied to determine the presence of sepsis;the patients were divided into qSOFA group and SIRS group according to the difference in the evaluation tools.The2012sepsis guideline was used as the definite standard,the diagnostic sensitivity and specificity of qSOFA and SIRS were analyzed and compared,and then the receiver operating characteristic curve(ROC)was drawn.Results Among the70patients with acute trauma,46were predicted to have sepsis by qSOFA and31were definitively diagnosed;47patients were predicted to have sepsis by SIRS,with29definitively diagnosed.The diagnostic sensitivity and specificity of qSOFA were86.11%and55.88%,respectively.The diagnostic sensitivity and specificity of SIRS were80.56%and48.57%,respectively.The area under the curve(AUC)of ROC in qSOFA group and SIRS group were0.71and0.64,respectively.There was no statistically significant difference in the AUC(P=0.276).The length of hospital stay in qSOFA and SIRS groups were(23.5±8.3)days and(30.1±14.3)days respectively,and the difference was statistically significant(P=0.002).The30d mortality rates of qSOFA and SIRS groups were6.5%and12.7%respectively;there was no statistically significant difference(P=0.504).Conclusions There is no difference in the sensitivity and specificity between qSOFA and SIRS scores in the diagnosis of sepsis after acute trauma.The qSOFA score can be used as a screening tool for early sepsis in patients with acute trauma.It is recommended to use qSOFA≥2as an early predictor of sepsis for emergency trauma patients.

关 键 词：快速序贯功能评分 脓毒症 创伤 

分 类 号：R641[医药卫生—外科学] R459.7[医药卫生—临床医学]