APACHE II和SOFA评分对不同原因休克预后评估的临床意义
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摘要
目的探讨在由不同原因导致的休克患者中APACHE II评分和SOFA评分之间的差异,同时评估SOFA评分变化趋势和不同原因休克患者死亡率之间的关系。方法收集2016年1月1日至2017年12月31日收治于北京大学人民医院呼吸与危重症医学科的58例休克患者的临床资料并行APACHE II和SOFA评分。将休克患者分为脓毒症休克和非脓毒症休克两组,并追踪患者30天生存率,比较存活患者和死亡患者在第1天APACHE II评分、SOFA评分及第3天SOFA评分以及两次SOFA差值间有无统计学意义。结果 (1)共入组脓毒症休克组患者36例,非脓毒症休克组患者22例,在这两组中第1天APACHE II评分、SOFA评分及第3天SOFA评分之间均无统计学差异(P>0.05)。(2)除脓毒症休克组存活患者与死亡患者第3天SOFA评分之间的差异有统计学意义(P<0.05)外,脓毒症休克组和非脓毒症休克组存活与死亡患者在第1天内APACHE II和SOFA评分间无统计学差异,脓毒症组存活与死亡患者在第3天SOFA评分无统计学差异。(3)两组休克患者在存活和死亡分组之间第1天和第3天SOFA变化值均存在统计学意义(P<0.05)。结论和APACHE II与单次SOFA评分相比,SOFA的变化程度更能提示患者病情转归情况,在临床中应予以充分重视以及时调整治疗方案,改善患者预后。
Objective To investigate the difference of APACHE II and SOFA in shock patients caused by sepsis or non-sepsis,and assess the correlation between thechange of SOFA and mortality.Methods The data of 58 shock patients who admitted in the RICU from Jan 1,2016 to Dec 31,2017 were collected to calculated the APACHE II and SOFA scores.The patients were divided into septic shock group and non-septic shock group,we analyzed the differences on APACHE II,SOFA and the change of SOFA between survivorsand non-survivors in each group.Results(1)There were 36 patients in septic shock group,and 22 patients in non-septic shock group.No statistics differences were identified in APACHE II,SOFA within 24 hours and SOFA in the third day between them.(2)Excepted the SOFA in the third day between survivors and non-survivors in non-septic shock group showed the statistical difference,there were no other difference on APACHE II and SOFA scores between survivors and non-survivors in each group.(3)The change of SOFA showed significant difference between the survivors and non-survivors in both group.Conclusion The change of SOFA was more effective to assess the outcome of shock patients than APACHE II and single SOFA score.It should be noticed in critical ill patients to permit physicians to adjust the treatment for improving the outcome.
Objective To investigate the difference of APACHE II and SOFA in shock patients caused by sepsis or non-sepsis,and assess the correlation between thechange of SOFA and mortality.Methods The data of 58 shock patients who admitted in the RICU from Jan 1,2016 to Dec 31,2017 were collected to calculated the APACHE II and SOFA scores.The patients were divided into septic shock group and non-septic shock group,we analyzed the differences on APACHE II,SOFA and the change of SOFA between survivorsand non-survivors in each group.Results(1)There were 36 patients in septic shock group,and 22 patients in non-septic shock group.No statistics differences were identified in APACHE II,SOFA within 24 hours and SOFA in the third day between them.(2)Excepted the SOFA in the third day between survivors and non-survivors in non-septic shock group showed the statistical difference,there were no other difference on APACHE II and SOFA scores between survivors and non-survivors in each group.(3)The change of SOFA showed significant difference between the survivors and non-survivors in both group.Conclusion The change of SOFA was more effective to assess the outcome of shock patients than APACHE II and single SOFA score.It should be noticed in critical ill patients to permit physicians to adjust the treatment for improving the outcome.
引文
[1]Vincent JL,De Backer D.Circulatory shock[J].J Engl J Med,2013,369(18):1726.
[2]Rhodes A,Evans LE,Alhazzani W,et al.Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016[J].Intensive Care Med,2017,43(3):304.
[3]于学忠,陆一鸣,王仲.急性循环衰竭中国急诊临床实践专家共识[J].中华急诊医学杂志,2016,25(2):143.
[4]Kaukonen KM,Bailey M,Suzuki S,et al.Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand,2000-2012[J].JAMA,2014,311(13):1308.
[5]Rivers E,Nguyen B,Havstad S,et al.Early goal-directed therapy in the treatment of severe sepsis and septic shock[J].N Engl JMed,2001,345(19):1368.
[6]Kellner P,Prondzinsky R,Pallmann L,et al.Predictive value of outcome scores in patients suffering from cardiogenic shock complicating AMI:APACHE II,APACHE III,Elebute-Stoner,SO-FA,and SAPS II[J].Med Klin Intensivmed Notfmed,2013,108(8):666.
[7]Knaus WA,Draper EA,Wagner DP,et al.APACHEⅡ:a severity of disease classfication system[J].Crit Care Med,1985,13(10):818.
[8]Jones AE,Trzeciak S,Kline JA.The sequential organ failure assessmentscore for predicting outcome in patients with severe sepsisand evidence of hypoperfusion at the time of emergency department presentation[J].Crit Care Med,2009,37(5):1649.
[9]Chen YX,Li CS.Arterial lactate improves the prognostic performance of severity score systems in septic patients in the ED[J].Am J Emerg Med,2014,32(9):982.
[10]Bale C,Kakrani AL,Dabadghao VS,et al.Sequential organ failure assessment score as prognostic marker in critically ill patients in a tertiary care intensive care unit[J].Int J Med Pubilic Health,2013,3(3):155.
[11]Haddadi A,Ledmani M,Gainier M,et al.Comparing the A-PACHE II,SOFA,LOD,and SAPS II scores in patients who have developed a nosocomial infection[J].Bangladesh Crit Care J,2014,2(1):4.
[12]Choi JY,Jang JH,Lim YS,et al.Performance on the APACHEII,SAPS II,SOFA and the OHCA score of post-cardiac arrest patients treated with therapeutic hypothermia[J].PLoS One,2018,13(5):e0196197.
[13]Cour M,Bresson D,Hernu R,et al.SOFA score to assess the severity of the post-cardiac arrest syndrome[J].Esuscitation,2016,102:110.
[2]Rhodes A,Evans LE,Alhazzani W,et al.Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016[J].Intensive Care Med,2017,43(3):304.
[3]于学忠,陆一鸣,王仲.急性循环衰竭中国急诊临床实践专家共识[J].中华急诊医学杂志,2016,25(2):143.
[4]Kaukonen KM,Bailey M,Suzuki S,et al.Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand,2000-2012[J].JAMA,2014,311(13):1308.
[5]Rivers E,Nguyen B,Havstad S,et al.Early goal-directed therapy in the treatment of severe sepsis and septic shock[J].N Engl JMed,2001,345(19):1368.
[6]Kellner P,Prondzinsky R,Pallmann L,et al.Predictive value of outcome scores in patients suffering from cardiogenic shock complicating AMI:APACHE II,APACHE III,Elebute-Stoner,SO-FA,and SAPS II[J].Med Klin Intensivmed Notfmed,2013,108(8):666.
[7]Knaus WA,Draper EA,Wagner DP,et al.APACHEⅡ:a severity of disease classfication system[J].Crit Care Med,1985,13(10):818.
[8]Jones AE,Trzeciak S,Kline JA.The sequential organ failure assessmentscore for predicting outcome in patients with severe sepsisand evidence of hypoperfusion at the time of emergency department presentation[J].Crit Care Med,2009,37(5):1649.
[9]Chen YX,Li CS.Arterial lactate improves the prognostic performance of severity score systems in septic patients in the ED[J].Am J Emerg Med,2014,32(9):982.
[10]Bale C,Kakrani AL,Dabadghao VS,et al.Sequential organ failure assessment score as prognostic marker in critically ill patients in a tertiary care intensive care unit[J].Int J Med Pubilic Health,2013,3(3):155.
[11]Haddadi A,Ledmani M,Gainier M,et al.Comparing the A-PACHE II,SOFA,LOD,and SAPS II scores in patients who have developed a nosocomial infection[J].Bangladesh Crit Care J,2014,2(1):4.
[12]Choi JY,Jang JH,Lim YS,et al.Performance on the APACHEII,SAPS II,SOFA and the OHCA score of post-cardiac arrest patients treated with therapeutic hypothermia[J].PLoS One,2018,13(5):e0196197.
[13]Cour M,Bresson D,Hernu R,et al.SOFA score to assess the severity of the post-cardiac arrest syndrome[J].Esuscitation,2016,102:110.