血乳酸联合qSOFA评分对早期筛选诊断脓毒症患者的价值  

The diagnostic value of blood lactate combined with qSOFA score for the early screening of sepsis patients

作　　者：张健峰 顾晓蕾 李斌[1] 庾胜 张碧波 ZHANG Jianfeng;GU Xiaolei;LI Bin;YU Sheng;ZHANG Bibo(Intensive Care Unit,Changshu No.2 People’s Hospital,Fifth Affiliated Clinical Medical College of Yangzhou University,Changshu,Jiangsu,215500,China)

机构地区：[1]扬州大学第五临床医学院,常熟市第二人民医院重症医学科,江苏常熟215500

出　　处：《临床急诊杂志》2021年第5期344-347,共4页Journal of Clinical Emergency

基　　金：2017年常熟市科技发展计划项目(No:CR201720)。

摘　　要：目的:探讨血乳酸联合快速序贯器官衰竭评分(qSOFA)评分对急诊脓毒症早期筛选诊断的价值。方法:选择在急诊抢救室就诊的506例疑似感染患者纳入研究。根据Sepsis 3.0诊断标准分为脓毒症组295例及非脓毒症组211例,统计所有患者qSOFA评分,乳酸联合qSOFA的Lac-qSOFA评分及SOFA评分,通过ROC曲线比较3种方法对脓毒症诊断的价值,分别计算敏感度和特异度等指标。结果:Lac-qSOFA评分与SOFA评分对脓毒症诊断的价值差异无统计学意义,与qSOFA评分对脓毒症诊断的价值差异有统计学意义。ROC曲线分析显示,qSOFA评分及Lac-qSOFA评分诊断脓毒症的截断值为1.5,qSOFA≥2分及Lac-qSOFA≥3分时,诊断脓毒症的敏感度分别为32%、26%,特异度分别为96%、98%。Lac-qSOFA≥2分时,诊断脓毒症的敏感度为67%,特异度为75%。结论:Lac-qSOFA评分诊断脓毒症比qSOFA评分诊断脓毒症更为准确,当Lac-qSOFA≥2分时,需高度怀疑脓毒症,对早期筛选诊断脓毒症更有价值。Objective: To explore the value of blood lactate combined with qSOFA in the early screening and diagnosis of emergency sepsis. Methods: Five hundred and six patients patients with suspected infection in the emergency department were selected in the study. According to the Sepsis 3.0 diagnostic criteria, they were divided into the sepsis group(n=295) and the non-sepsis group(n=211). All patients were assessed for qSOFA,Lac-qSOFA and SOFA. The diagnostic value of three methods for sepsis was compared by ROC curve, and the sensitivity and specificity were calculated respectively. Results: There was no significant difference between Lac-qSOFA and SOFA for the diagnosis of sepsis, but there was statistical difference between qSOFA and Lac-qSOFA. ROC curve analysis showed that the cut-off value of qsolfa score and lac qsolfa score in the diagnosis of sepsis was 1.5. When qsolfa score ≥ 2 and lac qsolfa score ≥ 3, the sensitivity of diagnosis of sepsis were 32%, 26%, 96% and 98%, respectively. When lac qsofea ≥ 2, the sensitivity and specificity were 67% and 75%, respectively.Conclusion: Lac-qSOFA score was more accurate in the diagnosing of sepsis than qSOFA score. When Lac-qSOFA ≥2, sepsis should be highly suspected, which was more valuable for the early screening of sepsis.

关 键 词：脓毒症 qSOFA Lac-qSOFA 诊断 

分 类 号：R459.7[医药卫生—急诊医学]