摘要
目的探讨动态监测序贯器官衰竭估计(SOFA)评分在危重病患者预后评估中的应用价值。方法选取本院重症科2010年5月—2011年9月收治的危重病患者84例为研究对象,4周内存活60例(存活组),死亡24例(死亡组)。分别于患者入ICU后第1、3、5、7天进行急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)和SOFA评分,比较两组不同时间APACHEⅡ和SOFA评分,分析器官损伤数与病死率及最大SOFA评分的关系及两组受损器官数和最大SOFA评分的差异。采用SPSS 13.0统计软件进行数据处理,计量资料采用t检验和方差分析,计数资料采用χ2检验。结果存活组患者入住ICU内1、3、5、7 d APACHEⅡ和SOFA评分与死亡组比较,差异均有统计学意义(P=0.00)。存活组患者入住ICU内1、3、5、7 d APACHEⅡ评分比较,差异有统计学意义(F=14.76,P=0.00);其中入住ICU内3、5、7 d与1 d时比较,差异均有统计学意义(q值分别为5.95、7.84和8.39,P=0.00)。死亡组患者入住ICU内1、3、5、7 d APACHEⅡ评分比较,差异无统计学意义(F=0.15,P=0.93)。存活组患者入住ICU内1、3、5、7 d SOFA评分比较,差异有统计学意义(F=18.27,P=0.00);其中入住ICU内3、5、7 d与1 d时比较,差异均有统计学意义(q值分别为5.04、8.06和9.74,P=0.00)。死亡组患者入住ICU内1、3、5、7 d SOFA评分比较,差异有统计学意义(F=5.35,P=0.00);其中入住ICU内5、7 d与1 d时比较,差异均有统计学意义(q值分别为2.98和5.03,P=0.00)。以受损器官3个为界,分为受损器官≥3个组和受损器官<3个组。受损器官≥3个组65例,死亡24例,病死率为36.92%;受损器官<3个组19例,无死亡患者,差异有统计学意义(χ2=9.82,P=0.00)。受损器官≥3个组存活患者最大SOFA评分为(7.73±2.23)分,死亡患者最大SOFA评分为(12.70±2.82)分,差异有统计学意义(t=-7.85,P=0.00);受损器官<3个组患者最大SOFA评分为(4.63±1.30)分。存活组和死亡组患者平均器官损伤数比较,差异有统计学意义(t=-6.65,P<0.05);两组SOFA评分中心血管、肾脏评分比较,差异均有统计学意义(P<0.05);两组SOFA评分中呼吸、凝血功能、肝脏、神经评分比较,差异均无统计学意义(P>0.05)。结论动态监测SOFA评分能更好地反映危重病患者器官损伤程度及治疗效果,有利于早期重点治疗方向的制定。
Objective To investigate the value of dynamic monitoring sequential organ failure assessment （SOFA） score in predicting outcome of critical ill patients. Methods Eighty - four critically ill patients admitted to ICU from May 2010 to September 2011 were divided into groups survival （n = 60, survived within 4 weeks）, death （n = 24）. Acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ） and SOFA score were performed on days 1, 3, 5, 7 after admission to ICU, to ana- lyze the relationship of number of damaged organs to mortality, maximum SOFA score. Results There was significant difference between 2 groups in APACHE II and SOFA on days 1, 3, 5, 7 after admission to ICU （P = 0. 00）. In survival group, there was difference in APACHE Ⅱ between days 1, 3, 5, 7 （F = 14. 76, P = 0.00）, and between days 3, 5, 7 and day 1 （q = 5.95, 7. 84, 8. 39, respectively, P=0. 00）. In death group, no difference was noted in APACHE Ⅱ between days 1, 3, 5, 7 （ F = 0. 15, P = 0. 93）. In survival group, there was difference in SOFA between days 1, 3, 5, 7 （F = 18. 27, P = 0. 00）, and between days 3, 5, 7 and day 1 （q = 5.04, 8. 06, 9. 74, respectively, P = 0. 00）. In death group, there was difference in SOFA between daysl, 3, 5, 7 （F=5.35, P=0.00）, and between days 3, 5, 7 and dayl （q=2.98, 5.03, respectively, P = 0. 00）. Twenty - four of t〉 3 - damaged - organ group （ n = 65） died （36. 92% ）, no patients died in 〈 3 - dam- aged - organ group （ n = 19）, the difference was significant （ x2 = 9.82, P = 0.00）. In ≥ 3 - damaged - organ group, the maximum SOFA of survival patients was （7. 73 ± 2. 23）, that of death （ 12. 70 ± 2. 82）, the difference was significant （ t = -7. 85, P = 0. 00） ; in 〈 3 - damaged - organ group, maximum SOFA was （4. 63 ± 1.30）. There was difference in average damaged organ number between groups survival and death （ P 〈 0.05 ）, and in scores of cardiovascular and kidney in SOFA （ P 〈 0. 05）, but there was not in scores of respiration, blood coagulation, liver, nerve （ P 〉 0. 05 ）. Conclusion Dynamic monito- ring SOFA, reflecting better the degree of organ damage and therapeutic effects in critically ill patients, is conductive to formula- tion of early treatment direction.
出处
《中国全科医学》
CAS
CSCD
北大核心
2012年第26期3071-3073,共3页
Chinese General Practice
