脓毒症性休克伴MODS患者的预后评分估计  

Use of two scoring systems in septic shock following multiple organ dysfunction syndrome

作　　者：俞凤[1] 赵良[2] 管军[2] 许永华[2] 杨兴易[2] 

机构地区：[1]安徽医科大学附属医院急诊科,安徽合肥230061 [2]中国人民解放军第二军医大学附属长征医院急救科ICU,上海200003

出　　处：《中国急救医学》2003年第4期219-220,共2页Chinese Journal of Critical Care Medicine

摘　　要：目的　探讨序贯器官衰竭估计 (SOFA)评分和简化多系统器官衰竭 (sMSOF)评分体系对脓毒症性休克伴多器官功能不全综合征 (MODS)的预后预测作用。方法　回顾性分析 5 1例脓毒症性休克伴MODS患者的资料 ,采用SOFA评分和sMSOF评分体系 ,分析这两种评分的入院评分、最大评分、△评分与预后的关系。结果　① 5 1例脓毒症性休克伴MODS患者中存活 7例 ,死亡 4 4例 ,两组在性别、年龄、住ICU时间、手术 /非手术、入院至脓毒症性休克发生时间无差异。② 5 1例患者在入ICU时或在ICU中均发生感染 ,感染部位以呼吸系统为多 (6 2 8% ) ,感染病原菌多为G-菌感染 (88 2 % ) ,合并霉菌感染 2 6例(5 1 0 % )。③入院SOFA评分两组无差异 ,最大SOFA评分和△SOFA评分死亡组明显高于存活组 (P <0 0 0 0 1)。最大sMSOF评分、△sMSOF评分死亡组明显高于存活组 (P <0 0 0 5 ,P <0 0 0 0 1) ,而入院sMSOF评分存活组反而明显高于死亡组。结论　在脓毒症性休克伴MODS患者 ,入院时的SOFA评分及sMSOF评分不能预测预后 ,二种评分的最大评分和△评分对预后有很好的预测作用。Objective To investigate sequential organ failure assessment (SOFA)scoring system and simple multiple system organ failure(sMSOF) scoring system in measuring the prognosis of patients with septic shock following multiple organ dysfunction syndrome(MODS).Methods A retrospective analysis was made in 51 patients with septic shock following MODS in a general ICU.The SOFA scoring system and sMSOF scoring system were used to compare the difference of admission scores,delta scores and maximum scores in survivors and nonsurvivors.Results ①There were no significantly differences in sex?age?ICU stay time?operation/non-operation and time of admission to developed sepsis syndrome between survivors and nonsurvivors.②All the 51 patients had infections in ICU stay.The most frequent site of infection in all 51 patients was respiratory tract (62 8%).Most of cultured organisms was Gram-negative bacilli (88 2%).26 patients had fungus (51 0%).③Total maximum SOFA scores and total delta SOFA scores in nonsurvivors were significantly higher than that in survivors( P <0 0001).There was no significant difference between two groups for total admission SOFA score.The maximum sMSOF scores and delta sMSOF scores in nonsurvivors were significantly higher than that in survivors ( P <0 0001),but admission sMSOF score in survivors was significantly higher than that in nonsurvivors.Conclusions The admission SOFA score and sMSOF score couldn't be used to predict the prognosis of patients with septic shock following MODS.The maximum scores and delta scores of SOFA scores and sMSOF scores were useful to predict the prognosis of patients with septic shock following MODS.

关 键 词：脓毒症性休克 多器官功能不全综合征 预后 预测 序贯器官衰竭估计评分 简化多系统器官衰竭评分 

分 类 号：R605.971[医药卫生—急诊医学]