急诊脓毒症病死率评分在急诊脓毒症休克患者中的应用研究

[目的]研究急诊脓毒症病死率评分(MEDS)对于急诊脓毒症患者病情评估的应用价值.[方法]对本院救治的316例脓毒症患者进行前瞻性研究.记录患者入院时的MEDS、急性生理学与慢性健康情况评价系统Ⅱ评分(APACHEⅡ)和血乳酸水平,比较28 d后患者的转归情况.根据MEDS分值将死亡风险分级:极低危险组(0~4分)、低度危险组(5~7分)、中度危险组(8~12分)、高度危险组(13~15分)、极高危险组(>15分),比较各组间实际病死率.根据患者是否生存进行分组,对生存组和死亡组的临床资料进行比较.应用受试者工作特征(ROC)曲线比较MEDS、APACHEⅡ和血乳酸对预后的预测能力.[结果]316例患者中,失访24例,完整记录292例.极低危险组、低度危险组、中度危险组、高度危险组、极高危险组的患者各组实际病死率分别为0%,11.4%,19.2%,47.1%,67.7%,各组间相比较差异均有显著性(P<0.05).生存组与死亡组患者年龄、乳酸水平、MEDS评分和APACHEⅡ评分相比较差异均具有显著性(P<0.05);而住院时间比较差异无显著性(P>0.05).ROC曲线显示MEDS评分,APACHEⅡ评分和血乳酸均是预测死亡的独立因素,其ROC曲线下的面积分别为0.807,0.713和0.730.[结论]MEDS评分可以对脓毒症患者死亡风险进行分级,对患者28 d病死率有较好的预测能力,适用于急诊脓毒症患者的预后预测.

Research of the Mortality in Emergency Department Sepsis Score for Emergency Department Pa-tients with Sepsis

[Objective]To research the value of mortality in emergency department sepsis score (MEDS) in emergency department patients with sepsis.[Methods]The 316 patients with sepsis were eligible for re-search and collected from March,2013 to September,2015.MEDS score,acute physiology,chronic health e-valuation Ⅱ (APACHE Ⅱ)score,and arterial blood lactate were tested and the outcomes in 28 days were re-corded.According to the sepsis score,all patients were divided into 5 mortality risk groups,namely very low risk group (0~4 points),low risk group (5~7 points),moderate risk group (8~12 points),high risk group (13~15 points),and very high risk group (more than 15 points).The mortality rates were compared in five groups and then all patients were divided into survivors and non-survivors.MEDS score,APACHE Ⅱ score, and arterial blood lactate were compared.Receiver operating characteristic curve (ROC curve)was used to test the value of prediction between APACHE Ⅱ score,MEDS score,and arterial blood lactate.[Results]Twenty-four patients were out of the follow-up and 292 patients were followed up completely among 316 patients.The actual mortality rates of very low risk group,low risk group,moderate risk group,high risk group and very high risk group were 0%,11.4%,19.2%,47.1%,and 67.7%,respectively.Significant differences were ob-served in age,the level of arterial blood lactate,MEDS score,and APACHE Ⅱ score between survivors and non-survivors (P <0.05),but not in hospital time.MEDS score,APACHE Ⅱ score,and arterial blood lac-tate were valid and eligible for predicating the risk of mortality in patients with sepsis by using ROC curve. ROC squares of the three factors were 0.807,0.713,and 0.730,respectively.[Conclusion]The sepsis score could be used to patients with sepsis and MEDS and was better for predicting 28 days mortality in Emergency department.