全科医学临床与教育

目的评估急性胃肠损伤(AGI)分级系统对严重脓毒症预后的评估价值。方法收集46例严重脓毒症患者进行AGI诊断和分期,然后根据4周内存活或死亡情况分为存活组26例和死亡组20例,每日进行AGI的评估,同时进行序贯器官衰竭评分(SOFA)、急性生理及慢性健康状况评分(APACHEⅡ),采用logistic多元回归分析方法评估它们对预后的预测,并采用ROC曲线评价各指标的诊断价值。结果所有严重脓毒症患者均出现AGI,发生率100%,AGI分级和第1天APACHEⅡ评分、最高SOFA评分、最高APACHEⅡ评分、入科时乳酸、6 h乳酸等5项指标之间有正相关性,和乳酸清除率、白蛋白等2项指标之间有负相关性,有统计学意义(P<0.05)。AGI分级、APACHEⅡ评分、SOFA评分判断严重脓毒症预后的曲线下面积分别为0.94、0.88、0.96。logistic多元回归分析显示,AGI分级≥1.25、SOFA评分≥7.70、APACHEⅡ评分≥11.80是严重脓毒症死亡的预测指标。结论 AGI分级对严重脓毒症有较好的预后评估作用,AGI分级≥1.25是严重脓毒症死亡的预测指标。

Objective To evaluate the value of acute gastrointestinal injury(AGI) degree system for assessing severe sepsis prognosis. Methods A total of 46 patients with severe sepsis were selected and diagnosed by AGI system. According the prognosis in 4 weeks, the patients were divided into survival group(26 cases) and death group(20 cases). At the first week after admission, the AGI degree, SOFA score and APACHEⅡ score were observed. The logistic regression analysis was executed to evaluate prediction of the AGI degree, SOFA score and APACHEⅡ score in severe sepsis prognosis,and their diagnosis values were compared by receiver-operating characteristic(ROC) curve. Results Patients with severe sepsis were occurred AGI with 100% incidence. AGI grading was positively correlative with 5 indexes including APACHEⅡ score, the highest SOFA score, the highest APACHEⅡ score, lactic acid at being hospitalized and 6 hours after hospitalized while was negative correlative with lactate clearance and albumin. The AUC of AGI grading, SOFA score and APACHE score for predicting severe sepsis prognosis were 0.94, 0.88, 0.96. Logistic multivariate regression analysis showed AGI grading ≥1.25, SOFA score≥7.70 and APACHE score≥11.80 were prediction index for the death of severe sepsis.Conclusion AGI scoring is valuable for the prognosis assessment of severe sepsis. AGI scoring≥1.25 is prediction index for the death of severe sepsis.