APACHEⅡ、SOFA及血乳酸对热射病合并MODS患者预后价值
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摘要
目的评估监测急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)及血乳酸等指标对于判断热射病合并多器官功能障碍综合征(MODS)患者的预后价值。方法采用判断抽样方法,以42例热射病合并MODS患者为研究对象,根据预后将其分为存活组(23例)和死亡组(19例),检测并比较2组患者入住重症加强护理病房(ICU)后APACHEⅡ、SOFA评分和血乳酸水平,通过受试者工作特征曲线(ROC曲线)分析各项指标对预后评估的价值。结果死亡组患者入住ICU 48 h内APACHEⅡ和SOFA评分均高于同时间点存活组(P<0.01)。死亡组患者入住ICU后6 h内血乳酸水平高于存活组(P<0.01);患者入住ICU 48 h时间点APACHEⅡ评分、SOFA评分以及第1、2、6小时血乳酸水平与预后均呈正相关(P<0.05)。ROC曲线分析结果显示,48 h APACHEⅡ评分、SOFA评分和3个时间点血乳酸评估热射病合并MODS患者预后效果较好(P<0.01)。结论动态监测APACHEⅡ、SOFA评分及血乳酸水平对于评估热射病合并MODS患者预后有重要临床意义。
Objective To evaluate the prognostic value of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure assessment(SOFA) score and the blood lactic acid in heat stroke patients combined with multiple organ dysfunction syndrome(MODS). Methods A judge sampling method was used to select 42 cases of heat stroke patients combined with MODS as study subjects. They were divided into survival group(23 cases) and death group(19 cases) according to prognosis. The APACHEⅡ, SOFA score and blood lactate level after admission to intensive care unit(ICU) were detected. The prognostic value of each index was analyzed according to receiver operating characteristic curve(ROC) curve. Results At the 48 th hour after admission to ICU, the APACHEⅡ and SOFA scores of the patients in the death group were higher than those in the survival group(P<0.05). At the 6 th hour after admission to ICU, the blood lactate level in the death group increased compare with that in the survival group(P<0.05). APACHEⅡ or SOFA scores at 48 hours, and the blood lactate levels at the 1 st, 2 nd, and 6 th hours after admission to ICU were all positively correlated with prognosis(P<0.05). ROC curve analysis showed that APACHEⅡ and SOFA scores at 48 hours, and the blood lactate levels at the 1 st, 2 nd, and 3 rd hours after admission to ICU could be used to evaluate the prognosis(P<0.01). Conclusion The dynamic monitoring of APACHEⅡ, SOFA score and the blood lactic acid have important clinical significance on the prognosis of heat stroke patients with MODS.
Objective To evaluate the prognostic value of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure assessment(SOFA) score and the blood lactic acid in heat stroke patients combined with multiple organ dysfunction syndrome(MODS). Methods A judge sampling method was used to select 42 cases of heat stroke patients combined with MODS as study subjects. They were divided into survival group(23 cases) and death group(19 cases) according to prognosis. The APACHEⅡ, SOFA score and blood lactate level after admission to intensive care unit(ICU) were detected. The prognostic value of each index was analyzed according to receiver operating characteristic curve(ROC) curve. Results At the 48 th hour after admission to ICU, the APACHEⅡ and SOFA scores of the patients in the death group were higher than those in the survival group(P<0.05). At the 6 th hour after admission to ICU, the blood lactate level in the death group increased compare with that in the survival group(P<0.05). APACHEⅡ or SOFA scores at 48 hours, and the blood lactate levels at the 1 st, 2 nd, and 6 th hours after admission to ICU were all positively correlated with prognosis(P<0.05). ROC curve analysis showed that APACHEⅡ and SOFA scores at 48 hours, and the blood lactate levels at the 1 st, 2 nd, and 3 rd hours after admission to ICU could be used to evaluate the prognosis(P<0.01). Conclusion The dynamic monitoring of APACHEⅡ, SOFA score and the blood lactic acid have important clinical significance on the prognosis of heat stroke patients with MODS.
引文
[1]张进进,王恒,房效莉,等.热射病合并多脏器功能障碍10例[J].中华灾害救援医学,2015,3(9):530-531.
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[4]沈丽娜,吴士文,张红英.热射病发病机制的研究进展[J].中国急救复苏与灾害医学杂志,2013,8(4):355-357.
[5]刘海周,程仁洪,郑青,等.实验室检查结果与劳力性热射病预后的相关性分析[J].中国急救复苏与灾害医学杂志,2011,6(8):719-722.
[6]刘涛,宁波,马宇洁.血乳酸及乳酸清除率对休克患者预后的评估[J].中国误诊学杂志,2011,11(10):2281-2283.
[7]杨巧云,刘文明,俞建峰,等.劳力性热射病患者血清降钙素原血培养的变化及其临床意义[J].中国急救医学,2015,35(2):129-132.
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[10]KNAUS W A,DRAPER E A,WAGNER D P,et al.APACHEⅡ:a severity of disease classification system[J].Crit Care Med,1986,13(10):818-829.
[11]VINCENT J L,MORENO R,TAKALA J,et al.The SOFA(Sepsisrelated Organ Failure Assessment)score to describe organ dysfunction/failure.On behalf of the Working Group on SepsisRelated Problems of the European Society of Intensive Care Medicine[J].Intensive Care Med,1996,22(7):707-710.
[12]李代波,周欢,刘乐斌.热射病的发病机制及防治研究进展[J].解放军预防医学杂志,2017,35(12):1598-1601.
[13]李博志,胡怀强,程明,等.3种评分量表对热射病预后评估的比较[J].医学研究生学报,2016,29(5):518-521.
[14]LEON L R,HELWIG B G.Heat stroke:role of the systemic inflammatory response[J].J Appl Physiol(1985),2010,109(6):1980-1988.
[15]HAIDRI F R,RIZVI N,MOTIANI B.Role of APACHE score in predicting mortality in chest ICU[J].J Pak Med Assoc,2011,61(6):589-592.
[16]VOSYLIUS S,SIPYLAITE J,IVASKEVICIUS J.Sequential organ failure assessment score as the determinant of outcome for patients with severe sepsis[J].Croat Med J,2004,45(6):715-720.
[17]HERN NDEZ-PALAZ N J,FUENTES-GARCIA D,BURGUIL-LOS-LPEZ S,et al.Analysis of organ failure and mortality in sepsis due to secondary peritonitis[J].Med Intensiva,2013,37(7):461-467.
[18]王洪亮,章志丹,黄伟.拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的解读与展望[J].中华重症医学电子杂志(网络版),2017,3(1):26-32.
[19]ARNOLD R C,SHAPIRO N I,JONES A E,et al.Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis[J].Shock,2009,32(1):35-39.
[20]韦树旺,韦廷求.动脉血乳酸及早期乳酸清除率在老年脓毒症治疗预后判断中的应用[J].中外医学研究,2017,15(3):37-38.
[21]刘伯飞,顾小宇,许晓蓉.重症中暑热射病32例救治分析[J].航空航天医学杂志,2013,24(11):1331-1333.
[22]张世安,汪晓,方坚,等.高温高湿条件下劳力性热射病致病特点与肝损伤机制[J].中国临床研究,2018,31(8):1025-1028,1032.
[2]陈长富,董文鹏,杨博,等.热射病致器官损伤的研究进展及治疗现状[J].实用医学杂志,2016,32(14):2272-2275.
[3]赵佳佳,周京江,胡婕,等.影响劳力性热射病预后的危险因素分析[J].中华危重病急救医学,2013,25(9):515-518.
[4]沈丽娜,吴士文,张红英.热射病发病机制的研究进展[J].中国急救复苏与灾害医学杂志,2013,8(4):355-357.
[5]刘海周,程仁洪,郑青,等.实验室检查结果与劳力性热射病预后的相关性分析[J].中国急救复苏与灾害医学杂志,2011,6(8):719-722.
[6]刘涛,宁波,马宇洁.血乳酸及乳酸清除率对休克患者预后的评估[J].中国误诊学杂志,2011,11(10):2281-2283.
[7]杨巧云,刘文明,俞建峰,等.劳力性热射病患者血清降钙素原血培养的变化及其临床意义[J].中国急救医学,2015,35(2):129-132.
[8]中华人民共和国卫生部.职业性中暑诊断标准:GBZ 41-2002[S].北京:法律出版社,2004.
[9]王今达,王宝恩.多器官功能失常综合征(MODS)病情分期诊断及严重程度评分标准[J].中国危重病急救医学,1995,7(6):346-347.
[10]KNAUS W A,DRAPER E A,WAGNER D P,et al.APACHEⅡ:a severity of disease classification system[J].Crit Care Med,1986,13(10):818-829.
[11]VINCENT J L,MORENO R,TAKALA J,et al.The SOFA(Sepsisrelated Organ Failure Assessment)score to describe organ dysfunction/failure.On behalf of the Working Group on SepsisRelated Problems of the European Society of Intensive Care Medicine[J].Intensive Care Med,1996,22(7):707-710.
[12]李代波,周欢,刘乐斌.热射病的发病机制及防治研究进展[J].解放军预防医学杂志,2017,35(12):1598-1601.
[13]李博志,胡怀强,程明,等.3种评分量表对热射病预后评估的比较[J].医学研究生学报,2016,29(5):518-521.
[14]LEON L R,HELWIG B G.Heat stroke:role of the systemic inflammatory response[J].J Appl Physiol(1985),2010,109(6):1980-1988.
[15]HAIDRI F R,RIZVI N,MOTIANI B.Role of APACHE score in predicting mortality in chest ICU[J].J Pak Med Assoc,2011,61(6):589-592.
[16]VOSYLIUS S,SIPYLAITE J,IVASKEVICIUS J.Sequential organ failure assessment score as the determinant of outcome for patients with severe sepsis[J].Croat Med J,2004,45(6):715-720.
[17]HERN NDEZ-PALAZ N J,FUENTES-GARCIA D,BURGUIL-LOS-LPEZ S,et al.Analysis of organ failure and mortality in sepsis due to secondary peritonitis[J].Med Intensiva,2013,37(7):461-467.
[18]王洪亮,章志丹,黄伟.拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的解读与展望[J].中华重症医学电子杂志(网络版),2017,3(1):26-32.
[19]ARNOLD R C,SHAPIRO N I,JONES A E,et al.Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis[J].Shock,2009,32(1):35-39.
[20]韦树旺,韦廷求.动脉血乳酸及早期乳酸清除率在老年脓毒症治疗预后判断中的应用[J].中外医学研究,2017,15(3):37-38.
[21]刘伯飞,顾小宇,许晓蓉.重症中暑热射病32例救治分析[J].航空航天医学杂志,2013,24(11):1331-1333.
[22]张世安,汪晓,方坚,等.高温高湿条件下劳力性热射病致病特点与肝损伤机制[J].中国临床研究,2018,31(8):1025-1028,1032.
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