MEWS、APACHEⅡ评分对不同证型ICU脓毒症患者预后的评估价值
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摘要
目的探讨改良早期预警评分(MEWS)、急性生理与慢性健康状况评估(APACHEⅡ)评分对不同证型ICU脓毒症患者预后的评估价值。方法选择2016年1月—2017年12月中国中医科学院广安门医院ICU治疗的脓毒症患者187例,入院后对其进行中医辨证分型及MEWS、APACHEⅡ评分。比较不同证型患者2项评分及病死率;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价2项评分对不同证型患者预后的评估价值并分析2项评分的相关性。结果病死率及2项评分从低到高依次为虚证、实证、虚实夹杂证,且虚证与其他2证比较差异有统计学意义(P<0.05)。2项评分可有效评估实证、虚实夹杂证患者预后,二者呈正相关(P<0.01),不同证型患者2项评分最佳截断点前后病死率比较差异有统计学意义(P<0.05)。结论 MEWS、APACHEⅡ评分对实证、虚实夹杂证脓毒症患者预后有较高的评估价值。
Objective To explore the evaluation value of modified early warning score(MEWS)and acute physiology and chronic health evaluation score(APACHEⅡ)score on prognosis of sepsis patients with different syndrome types in ICU.Methods 187 sepsis patients in ICU of Guang′anmen Hospital of China Academy of Chinese Medical Sciences from January 2016 to December 2017 were scored in TCM syndrome types, MEWS and APACHE Ⅱ.The scores of two different types of syndromes were compared, as well as the mortality of different syndrome types, the two ROC curves drawn, the correlation and the AUC calculated,prognostic evaluation value of scores in two types evaluated;the correlation of scores of types.Results The mortality and two kinds of scores from low to high were the deficiency syndrome,excessive syndrome, syndrome of intermingled deficiency and excess, and the deficiency syndrome and the other two syndromes were statistically different(P<0.05).The two scores of syndrome of intermingled deficiency and excess could effectively predict the death condition, and the correlation was significantly correlated with the Spearman test(P<0.01);the mortality rates before and after the best truncation point of different syndrome type two scores were compared.The difference was statistically significant(P< 0.05).Conclusion Two scores can evaluate the condition and evaluate the prognosis in the evidence and deficiency syndrome.
Objective To explore the evaluation value of modified early warning score(MEWS)and acute physiology and chronic health evaluation score(APACHEⅡ)score on prognosis of sepsis patients with different syndrome types in ICU.Methods 187 sepsis patients in ICU of Guang′anmen Hospital of China Academy of Chinese Medical Sciences from January 2016 to December 2017 were scored in TCM syndrome types, MEWS and APACHE Ⅱ.The scores of two different types of syndromes were compared, as well as the mortality of different syndrome types, the two ROC curves drawn, the correlation and the AUC calculated,prognostic evaluation value of scores in two types evaluated;the correlation of scores of types.Results The mortality and two kinds of scores from low to high were the deficiency syndrome,excessive syndrome, syndrome of intermingled deficiency and excess, and the deficiency syndrome and the other two syndromes were statistically different(P<0.05).The two scores of syndrome of intermingled deficiency and excess could effectively predict the death condition, and the correlation was significantly correlated with the Spearman test(P<0.01);the mortality rates before and after the best truncation point of different syndrome type two scores were compared.The difference was statistically significant(P< 0.05).Conclusion Two scores can evaluate the condition and evaluate the prognosis in the evidence and deficiency syndrome.
引文
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[5] 温伟,杨鲁,张新超.国家早期预警评分联合动脉血乳酸对不同类型急诊老年危重症患者死亡预测的研究[J].临床急诊杂志,2017,18(3):204-207.
[6] Bouadma L,Luyt CE,Tubach F,et al.Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial):a multicentre randomised controlled trial[J].Lancet,2010,375(9713):463-474.
[7] Huang Y,Chen J,Zhong S,et al.Role of APACHEⅡ scoring system in the prediction of severity and outcome of acute intracerebral hemorrhage[J].Int J Neurosci,2016,126(11):1020-1024.
[8] 刘清泉,蓝海涛,赵红芳,等.重度脓毒症中医证候与APACHEⅡ评分相关性的临床研究[J].北京中医,2007,26(4):208-210.
[2] 中国中西医结合学会急救医学专业委员会,《中国中西医结合急救杂志》编辑委员会.脓毒症中西医结合诊治专家共识[J].中华危重病急救医学,2013,25(4):194-197.
[3] 郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版,2002:134-139.
[4] 国家技术监督局.GB/T 16751.2-1997中医临床诊疗术语·证候部分[S].北京:中国标准出版社,2004.
[5] 温伟,杨鲁,张新超.国家早期预警评分联合动脉血乳酸对不同类型急诊老年危重症患者死亡预测的研究[J].临床急诊杂志,2017,18(3):204-207.
[6] Bouadma L,Luyt CE,Tubach F,et al.Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial):a multicentre randomised controlled trial[J].Lancet,2010,375(9713):463-474.
[7] Huang Y,Chen J,Zhong S,et al.Role of APACHEⅡ scoring system in the prediction of severity and outcome of acute intracerebral hemorrhage[J].Int J Neurosci,2016,126(11):1020-1024.
[8] 刘清泉,蓝海涛,赵红芳,等.重度脓毒症中医证候与APACHEⅡ评分相关性的临床研究[J].北京中医,2007,26(4):208-210.