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各种评分系统预测需要急诊重症监护的慢性阻塞性肺疾病急性加重患者 28 天生存率的疗效。

Efficacy of Various Scoring Systems for Predicting the 28-Day Survival Rate among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Requiring Emergency Intensive Care.

机构信息

Department of Respiratory Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.

Department of Emergency Medicine, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.

出版信息

Can Respir J. 2017;2017:3063510. doi: 10.1155/2017/3063510. Epub 2017 May 25.

Abstract

We aimed to investigate the efficacy of four severity-of-disease scoring systems in predicting the 28-day survival rate among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring emergency care. Clinical data of patients with AECOPD who required emergency care were recorded over 2 years. APACHE II, SAPS II, SOFA, and MEDS scores were calculated from severity-of-disease indicators recorded at admission and compared between patients who died within 28 days of admission (death group; 46 patients) and those who did not (survival group; 336 patients). Compared to the survival group, the death group had a significantly higher GCS score, frequency of comorbidities including hypertension and heart failure, and age ( < 0.05 for all). With all four systems, scores of age, gender, renal inadequacy, hypertension, coronary heart disease, heart failure, arrhythmia, anemia, fracture leading to bedridden status, tumor, and the GCS were significantly higher in the death group than the survival group. The prediction efficacy of the APACHE II and SAPS II scores was 88.4%. The survival rates did not differ significantly between APACHE II and SAPS II ( = 1.519). Our results may guide triage for early identification of critically ill patients with AECOPD in the emergency department.

摘要

我们旨在研究四种疾病严重程度评分系统在预测需要紧急护理的慢性阻塞性肺疾病急性加重(AECOPD)患者 28 天生存率方面的疗效。记录了 2 年来需要紧急护理的 AECOPD 患者的临床数据。从入院时记录的疾病严重程度指标中计算出了 APACHE II、SAPS II、SOFA 和 MEDS 评分,并比较了入院后 28 天内死亡(死亡组;46 例)和未死亡(存活组;336 例)患者的评分。与存活组相比,死亡组的 GCS 评分、合并症(包括高血压和心力衰竭)的频率和年龄显著更高(所有 P 值均<0.05)。在所有四个系统中,年龄、性别、肾功能不全、高血压、冠心病、心力衰竭、心律失常、贫血、导致卧床不起的骨折、肿瘤和 GCS 的评分在死亡组均显著高于存活组。APACHE II 和 SAPS II 评分的预测效果为 88.4%。APACHE II 和 SAPS II 的生存率没有显著差异(=1.519)。我们的研究结果可能有助于急诊科对 AECOPD 危重症患者进行早期分诊。

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