中医辨证联合各指标对脓毒症预后价值的研究
刘静,俞冲
摘要(Abstract)：
目的探讨中医辨证联合序贯器官衰竭估计评分(SOFA)、急性生理与慢性健康评分(APACHEⅡ)、血清降钙素原(PCT)、动脉乳酸(LAC)对脓毒症预后的预测价值。方法采用前瞻性研究方法,收集并分析2015-2017年我院急诊ICU收治的脓毒症患者临床资料。结果不同中医证型(卫气同病证、气分实热证、气分湿热证及气营两燔证)、不同病情严重程度(一般脓毒症、严重脓毒症及脓毒性休克)组间比较:合并多脏器功能衰竭、SOFA评分、APACHEⅡ评分、血清PCT及动脉LAC水平差异有统计学意义(P <0.05)。不同预后组间比较:合并基础疾病、合并多脏器功能衰竭、SOFA评分、APACHEⅡ评分、血清PCT及动脉LAC水平差异有统计学意义(P <0.05);气营两燔证、气分湿热证、脓毒性休克、入院24 h内SOFA及APACHEⅡ评分、血清PCT及动脉LAC水平等指标是脓毒症患者预后的影响因素,其中气营两燔证、脓毒性休克、动脉LAC水平OR值分别高达4.255、5.118和5.078(P <0.05);进一步绘制受试者工作特征曲线(ROC)提示SOFA评分(界值12.36)、APACHEⅡ评分(界值23)、血清PCT(界值6.02)及动脉LAC水平(界值5.04)对于脓毒症患者发生死亡转归的预测效能相当,曲线下面积均在0.9以上。结论中医辨证联合SOFA评分、APACHEⅡ评分、血清PCT及动脉LAC水平检测可用来判断脓毒症患者的预后。
关键词(KeyWords)： 脓毒症;中医辨证;SOFA;评分;APACHEⅡ评分;降钙素原;乳酸;预后
基金项目(Foundation):
作者(Author): 刘静,俞冲
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