摘要
目的探讨联合应用早期体温峰值及48h-ΔSOFA评分对急诊脓毒症患者预后评估的临床价值。方法本文为回顾性的临床研究，分析从2013年1月到2015年1月中国医科大学附属第一医院急诊科ICU收治的231例脓毒症患者，收集患者的一般资料、早期体温峰值、入急诊科ICU时和48h后的SOFA评分、在急诊ICU入住的时间及患者在28d内的生存情况。根据48h-ΔSOFA评分数值的正负将患者分为两组，每组分别以早期体温峰值再分为三个亚组，即低体温组（早期体温峰值〈36℃）、正常体温组（早期体温峰值36—38℃）和高体温组（早期体温峰值〉38℃）。分析早期体温峰值及48h-ΔSOFA评分与患者的生存情况及入住急诊ICU治疗时间的关系。结果在231例入选的脓毒症患者中48h-ΔSOFA〉0的患者有142例（61．5％），其中27例（19．0％）死亡，48h-ΔSOFA≤0的患者有89例（38．5％），其中33例（37．1％）死亡，两组间差异具有统计学意义（P〈0．05）；在48h-ΔSOFA≤0的患者组中，低体温亚组患者在28d内发生死亡的风险比例是体温正常亚组患者的4．51倍（OR=4．51，95％CI：1．33—2．17，P=0．01）；在48h-ΔSOFA〉0的患者组中，高体温亚组患者入住急诊ICU的时间为12．3（7．2—15．3）d，明显高于低体温亚组7．5（3．6～10．2）d和体温正常亚组6．2（4．4—8．7）d，组间差异具有统计学意义（P〈0．05）。结论联合应用早期体温峰值及48h-ΔSOFA评分是对急诊脓毒症患者预后评估的有效指标，利于对患者进行早期分层。体温峰值〈36℃且48h-ΔSOFA≤0的患者的病死率较高，临床上应给予重视；体温峰值〉38℃且48h-ΔSOFA〉0的患者的住院时间较长，临床上应及时评估病情并合理更改治疗方案，以减短患者的住院时间。
Objective To investigate the joint value of early peak temperature and 48 h-Δsequential organ failure assessment （SOFA） score in predicting the prognosis for patients with sepsis in emergency department. Methods Two hundred and thirty-one patients with sepsis admitted from January 2013 to January 2015 in Emergency Intensive Care Unit of the First Affiliated Hospital of China Medical University were enrolled. Clinical features, early peak temperature, SOFA scores, the length of stay in EICU and the mortality in 28 days were studied. The patients were divided into two groups according to the 48 h-ΔSOFA. Each group were divided into three subgroups according to the early peak temperature. For example, hypothermia subgroup had temperature below 36℃, normothermia subgroup had temperature between 36 ℃ and 38 ℃, and hyperthermia subgroup had temperature above 38 ℃. The relationship between peak temperature plus 48 h- ASOFA and the length of stay in EICU as well as mortality were analyzed. Results Of 231 patients, in 48 h- ΔSOFA〉O group （n = 142） 27 （19.0%） patients died, and in 48 h-ΔSOFA≤0 group （n =89） 33 （37. 1% ） patients died （P 〈 0. 05 ）. Hypothermia subgroup had a higher odds ratio value in predicting nonsurvivalin 48 h-ΔSOFA≤0 group （OR =4.51, 95% CI： 1.33 -2.17, P = 0.01）. Hyperthermia subgroup had a longer stay in EICU than hypothermia subgroup and normothermia subgroup （ P 〈 0.05 ）. Conclusion The combination of the early peak temperature and 48h-ΔSOFA score is an effective indicator to evaluate the prognosis and to stratify patients with sepsis in emergency department. More attention should be paid to the patients with an early peak temperature 〈 36℃ and 48 h-ΔSOFA ≤0 because of higher mortality. The condition of patients should be reassessed and try to make a more rational treatment for the patients with an early peak temperature 〉 38℃ and 48 h-ΔSOFA 〉 0 because of its longer stay in EICU.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2016年第1期68-72,共5页
Chinese Journal of Emergency Medicine
关键词
脓毒症
SOFA评分
早期体温峰值
预后
Sepsis
Sequential organ failure assessment
Early peak temperature
Prognosis
