三种不同DIC评分对脓毒性休克器官功能损伤和预后评估的应用价值

doi:10.3969/j.issn.1002-1949.2019.02.014

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摘要目的探讨国际血栓与止血协会（The International Society of Thrombisis and Hemostasis, ISTH）评分标准、日本急诊医学学会（Japanese Association for Acute Medicin, JAAM）、评分标准和中国弥散性血管内凝血诊断积分系统（Cheinese disseminated intravascular coagulation scoring, CDICS）三种弥漫性血管内凝血（disseminated intravascular coagulation， DIC)评分在评估脓毒性休克患者器官功能损伤和预后评估中的应用价值。方法回顾性分析96例脓毒性休克患者，记录临床资料及28 d病死率，进行ISTH评分、JAAM评分及CDICS评分，并分为DIC组和非DIC（NODIC）组，分析两组器官功能损伤、危重程度及预后的差异。结果 ①脓毒性休克患者中，生存组的ISTH评分低于死亡组，分别为3（2,5）和4（3,6），差异有统计学意义（P=0.049）；但生存组和死亡组的JAAM评分、CDICS评分差异均无统计学意义（P＞0.05）；②脓毒性休克患者中，ISTH评分、JAAM评分、CDICS评分与APACHEⅡ评分、SOFA评分均具有一定的相关性，r值分别为0.335、0.434、0.444（vs. APACHEⅡ评分）和0.443、0.559、0.632（vs. SOFA评分）；③以不同DIC评分为DIC诊断标准，DIC组和NODIC组死亡构成比差异无统计学意义（P＞0.05），但DIC组的危重度（APACHEⅡ评分）和器官功能损伤程度（SOFA评分）均明显高于NODIC组（P＜0.05）；④采用ROC曲线分析三种DIC评分预测脓毒性休克28 d病死率，曲线下面积分别为0.626、0.578、0.613。结论 ISTH评分、JAAM评分、CDICS评分有助于评估脓毒性休克患者的器官功能损伤和危重程度，但对28 d病死率的预测价值欠佳，CDICS评分应用于脓毒性休克时与ISTH评分、JAAM评分具有类似的评估价值。

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关键词 ：脓毒性休克, 弥漫性血管内凝血（DIC), DIC评分, 预后

通讯作者: 张丹（1970-），女，博士，主任医师，E-mail:doctor-zhangdan@126.com。

引用本文:

陈晓迎，张燕，张丹. 三种不同DIC评分对脓毒性休克器官功能损伤和预后评估的应用价值[J]. 中国急救医学, 2019, 39(2): 170-174.
Chen Xiao-ying, Zhang Yan, Zhang Dan. Evaluation of ISTH, JAAM and CDICS for predicting organ dysfunction and mortality in septic shock. Chinese Journal of Critical Care Medicine, 2019, 39(2): 170-174.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.02.014 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I2/170

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