序贯器官衰竭评分对急性中毒病情及预后的评价

目的 评估急性中毒患者器官衰竭情况,研究序贯器官衰竭评分(SOFA)与急性中毒患者预后的关系.方法 回顾性分析2006年6月至2007年6月中国医科大学附属一院急诊ICU收治的76例急性中毒患者的临床资料,收集其入院即刻及入院后48 h的心率、血压、血氧饱和度、血气、血常规、肝功能、肾功能、心肌酶谱、血糖值及神志状态,并记录各时间段应用的血管活性药物的剂量,对其进行分段SOFA评分(人院即刻和入院后48 h),比较存活组与死亡组不同时间点的SOFA评分是否存在差异,评估SOFA评分与预后的关系.结果 入院即刻累计SOFA评分(s0FAu)在死亡组与存活组中差异无统计学意义(P=0.26),48 h累计s0FA评分(soFA48)及两者之差(ΔSOFA)在两组中差异具有统计学意义(P<0.01).Logistic回归分析结果显示48 h SOFA评分中的肾脏及神经系统的评分是急性中毒患者预后的独立危险因素(P值分别为0.003和0.012),Speannan秩相关分析结果提示ALT、CK-MB、WBC、BE值及血糖值(BG)与SOFA48有相关性(P<0.05).结论 SOFA评分与急性中毒患者预后呈相关趋势,而动态观察SOFA评分的变化对评价病情严重程度及判断预后具有重要意义.

Sequential organ failure assessment score in evaluation of the outcome of patients with acute poisoning

Objective To analyze the status of multiple organ failure in patients with acute poisoning and to investigate the relationship between sequential organ failure assessment (SOFA) and prognosis. Method A retrospective review of 76 patients admitted to emergency intensive care unit in the First Affiliated Hospital of China Medical University for acute poisoning was carried out. Data about heart rate, blood pressure, blood oxygen saturation, blood gas analysis, rutine blood examination (WBC,platelet,albumin, ALT,total bilirubin, BUN,creatinine, CK, CK-MB, blood glucose), dosage of vascular active agents and mental status were documented at admission and 48 h after admission. SOFAs were counted at admission (SOFA ) and 48 h after admission (SOFA ) and then a comparison was made between survivors and victims. Results There was no significant difference in SOFA between survivors and victims ( P = 0.26) , but significant difference in SOFA48 as well as SOFA was shown between survivors and victims (P < 0.01). Multivariate logistic regression analysis indicated that the SOFA48 of renal and nervous systems were the independent predictors with acute poisoning (P = 0.003 and 0.012 respectively). Spearman correlation analysis implicated that ALT,CK-MB, WBC,base excess (BE) and blood glucose (BG) had correlation with SOFAs48. Conclusions SOFA shows its score eorrellated with the prognosis of poisoning with a-cute poisoning and it is a practical method in eveluating the outcome of patients with acute poisoning.