入院前FRAIL評(píng)分和入室后SOFA評(píng)分與膿毒性休克患者預(yù)后的關(guān)系

尹燕燕　董秉生　姜利

[摘要] 目的 探討膿毒性休克患者入院前FRAIL評(píng)分及入室的第一個(gè)24小時(shí)序貫器官衰竭評(píng)分（SOFA）與其預(yù)后的關(guān)系，以指導(dǎo)臨床醫(yī)師選擇合適治療時(shí)機(jī)及時(shí)救治。 方法 選擇2016年1月～2018年2月首都醫(yī)科大學(xué)附屬?gòu)?fù)興醫(yī)院ICU收治住院的113例膿毒性休克患者，以入室28 d作為觀察終點(diǎn)，將28 d內(nèi)繼續(xù)在ICU治療或者治愈出院或者轉(zhuǎn)至普通病房者作為生存組，將入ICU 28 d內(nèi)死亡者作為死亡組。比較兩組患者的一般資料、FRAIL評(píng)分、急性生理和慢性健康狀況評(píng)分（APACHE Ⅱ）、動(dòng)脈血乳酸（LAC）及降鈣素原（PCT）水平等;采用Logistic回歸模型分析患者預(yù)后的影響因素;單獨(dú)使用SOFA、FRAIL和聯(lián)合SOFA和FRAIL預(yù)測(cè)膿毒性休克的死亡風(fēng)險(xiǎn)，并繪制出ROC曲線，觀察FRAIL評(píng)分和SOFA評(píng)分對(duì)膿毒癥休克患者預(yù)后的預(yù)測(cè)價(jià)值。 結(jié)果 28 d觀察終點(diǎn)時(shí)，生存53例，死亡60例。兩組入室PCT、FRAIL、SOFA比較，差異有統(tǒng)計(jì)學(xué)意義（P < 0.05）;將上述3個(gè)指標(biāo)作為自變量，將生存和死亡作為因變量，進(jìn)行Logistic回歸分析，膿毒性休克死亡的預(yù)警方程為logit（P）= -16.045+1.608×FRAIL+1.235×SOFA。SOFA和FRAIL聯(lián)用對(duì)預(yù)測(cè)膿毒性休克死亡的預(yù)測(cè)價(jià)值最大（AUC=0.928，P < 0.01）。 結(jié)論 影響ICU膿毒癥患者預(yù)后的因素較多，聯(lián)合FRAIL評(píng)分和SOFA評(píng)分是預(yù)測(cè)ICU膿毒癥患者死亡較為簡(jiǎn)單有效的指標(biāo)。

[關(guān)鍵詞] 膿毒性休克;FRAIL;序貫器官衰竭評(píng)分;預(yù)后

[中圖分類號(hào)] R459.7? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1673-7210（2019）06（b）-0105-05

Relationship between the pre-admission FRAIL score and SOFA score after admission of patients with septic shock and their prognosis

YIN Yanyan1? ?DONG Bingsheng2? ?JIANG Li2

1.Urinary and Metabolic Center， Beijing Rehabilitation Hospital Affiliated to Capital Medical University， Beijing? ?100144， China; 2.Department of Critical Care Medicine， Fuxing Hospital Affiliated to Capital Medical University， Beijing? ?100038， China

[Abstract] Objective To investigate the relationship between the pre-admission FRAIL score and the first 24-hour sequential organ failure score （SOFA） after admission of patients with septic shock and their prognosis， so as to guide clinicians to choose appropriate treatment time and timely treatment. Methods From January 2016 to February 2018， 113 patients with septic shock who were hospitalized in the ICU of the Fuxing Hospital Affiliated to Capital Medical University， were enrolled. The 28-day entry was used as the end point of observation endpoint， and those who continued to be treated or cured or discharged from ICU within 28 days as survival group observation， and those who died within 28 days as death group. The general data， FRAIL score， acute physiology and chronic health evaluation score （APACHEⅡ）， arterial blood lactate （LAC） and procalcitonin （PCT） levels were compared between the two groups. Logistic regression model was used to analyze the prognostic factors of patients. The mortality risk of septic shock was predicted by SOFA， FRAIL alone and combined with SOFA and FRAIL， and the ROC curve was drawn to observe the predictive value of FRAIL scores and SOFA scores for prognosis in patients with septic shock. Results At the end of 28 days， 53 patients survived and 60 died. There were significant differences in PCT， FRAIL and SOFA between the two groups （P < 0.05）. The above three indicators were used as independent variables， survival and death were used as dependent variables， Logistic regression analysis was performed， and the early warning equation of septic shock death was used. It is logit （P） =-16.045+1.608×FRAIL+1.235×SOFA. The combination of SOFA and FRAIL had the greatest predictive value for predicting septic shock death （AUC=0.928， P < 0.01）. Conclusion There are many factors influencing the prognosis of patients with sepsis in ICU. Combined FRAIL score and SOFA score are simple and effective indicators for predicting death in patients with sepsis in ICU.

[Key words] Septic shock; FRAIL; Sequential organ failure score; Prognosis

隨著人口老齡化的到來(lái)，ICU工作者深深感受到了患者衰弱現(xiàn)象的普遍性。“衰弱”指隨著年齡的增加，全身各器官生理儲(chǔ)備和生理功能逐漸下降而導(dǎo)致老年人處于一種易損狀態(tài)，即身體面臨新的創(chuàng)傷及應(yīng)激時(shí)，極易向病態(tài)發(fā)展的一種狀態(tài)。Fried等[1-2]將該狀態(tài)定義為“衰弱”，并制訂了衰弱表型評(píng)估（FP），用于評(píng)價(jià)衰弱的程度。而膿毒癥是由于感染而導(dǎo)致的一系列病理、生理方面的異常，是導(dǎo)致全世界感染患者致死致殘的重要因素。膿毒性休克則是指膿毒癥患者盡管經(jīng)充分液體復(fù)蘇后，仍存在持續(xù)低血壓的狀態(tài)，需要使用升壓藥維持平均動(dòng)脈壓>65 mmHg（1 mmHg = 0.133 kPa），乳酸水平多>2.0 mmol/L[3]。本研……