| 吴昆鹏，陈莹，李方，言彩红，黄治家，桂培根.血乳酸、降钙素原及APACHE Ⅱ评分联合对.[J].中南医学科学杂志.,2015,43(4):439-442. |
| 血乳酸、降钙素原及APACHE Ⅱ评分联合对 |
| Assessment of Early Diagnosis and Prognostic of Severe Trauma Sepsis Patients with Combination of Lac,Procalcitonin and APACHE Ⅱ Scores |
| 投稿时间：2015-04-22 |
| DOI： |
| 中文关键词: 乳酸 降钙素原 APACHE Ⅱ评分 脓毒症 |
| 英文关键词:lactic acid procalcitonin APACHE Ⅱ score sepsis |
| 基金项目: |
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| 中文摘要: |
| 目的 评价血乳酸（Lac）、降钙素原（PCT）及APACHE Ⅱ评分联合监测对脓毒症患者诊断及预后的评估价值，探索评估脓毒症患者预后的有效指标。 方法 回顾分析入住ICU的严重创伤患者137例，检测血清Lac、PCT并行APACHE Ⅱ评分，用ROC曲线及生存分析法评估联合监测3项指标诊断脓毒症及预后的价值。 结果 137例患者中脓毒症患者57例，脓毒症患者第1天血清Lac、PCT浓度及APACHE Ⅱ评分均较存非脓毒症患者升高（P<0.05）。血清Lac、PCT及APACHE Ⅱ评分联合诊断脓毒症的ROC曲线下总面积分别为0.809（95%CI：0.738～0.881）、0.909（95%CI：0.859～0.959）、0.830（95%CI：0.760～0.900），最佳临界值分别为4.25 μmol/L、1.8 ng/mL、8.5分。制定联合评分后，2分及以上的曲线下面积为0.910（95%CI：0.853～0.967），诊断脓毒症的敏感性为89.5%，特异性为92.5%。联合评分1～3分之间28天死亡率有明显差异（P<0.05）。 结论 Lac、PCT及APACHE Ⅱ评分联合评分能有效的早期诊断脓毒症，并可有效评估预后。 |
| 英文摘要: |
| Objective To assess the value of combined determination of blood serum lactic acid （Lac）,procalcitonin （PCT） and APACHE Ⅱ grade point for the early diagnosis and prognostic assessment of sepsis in severe trauma patients. Methods The severe trauma patients admitted to ICU were enrolled.The levels of Lac,PCT and APACHE Ⅱ score were determined,and the ROC curve and survivor curve were plotted to analyze the diagnostic and prognostic value of the combined determination of three indicators. Results A total of 137 severe trauma patients were enrolled and 57 patients were demonstrated as sepsis.The serum Lac,PCT level and APACHE Ⅱ grade points of patients with sepsis were higher than patients without sepsis in the first day（P<0.05）.The AUCROC of plasma Lac,PCT lever and APACHE Ⅱ grade points were 0.809（95%CI：0.738～0.881）,0.909 （95%CI：0.859～0.959）,0.830（95%CI：0.760～0.900）and the cut off values were 4.25μmol/L,1.8ng/mL,8.5 scores.The AUCROC with the Joint score of more than 2 was 0.910（95%CI：0.853～0.967）.The sensitivity of the diagnosis of sepsis was 89.5%.Specificity was 92.5%,the 28 day mortality between Joint score 1～3 score had obvious difference（P<0.05）. Conclusion Combination of scores with Lac,PCT and APACHE Ⅱ score was effective for early diagnosis and prognostic assessment of sepsis. |
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