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目的比较不同预后急性脑卒中合并发多器官功能障碍综合征患者APACHEⅢ、MODS、SOFA、LODS评分,对其临床特点和致死危险因素进行分析,为降低该疾病致死率提供依据。方法回顾性分析2011年12月—2013年9月ICU收治的134例急性脑卒中合并多器官功能障碍患者病例。根据预后分为死亡组和存活组,采用急性生理学与慢性健康状况评分系统Ⅲ(APACHEⅢ)、多脏器功能不全评分(MODS)、序贯性器官衰竭评分(SOFA)评分标准、Logistic脏器功能不全评分(LODS评分)对2组患者进行评分。并采用Logistic回归分析对APACHEⅢ评分、MODS评分、SOFA评分、LODS评分、血糖水平、C反应蛋白水平、基础疾病积分进行多因素分析,评估预后相关危险因素。结果生存组患者年龄、APACHEⅢ评分、MODS评分、SOFA评分、LODS评分均显著性低于死亡组(P<0.05)。Logistic回归分析结果:血糖>7.8 mmol/L、C反应蛋白、基础疾病评分、APACHEⅢ评分、MODS评分、LODS评分、SOFA评分是影响患者预后的独立危险因素。结论 APACHEⅢ、MODS、SOFA、LODS评分有助于对急性脑卒中合并发多器官功能障碍综合征患者做出预后判断,高血糖、C反应蛋白、基础疾病是影响预后的独立危险因素。
Objective To compare the APACHE Ⅲ, MODS, SOFA and LODS scores in patients with acute stroke and multiple organ dysfunction syndrome, and to analyze their clinical features and lethal risk factors, so as to provide the basis for reducing the lethality of this disease. Methods A retrospective analysis of 134 patients with acute stroke complicated with multiple organ dysfunction admitted to the ICU from December 2011 to September 2013 was performed. According to the prognosis, the patients were divided into death group and survival group. APACHE III, MODS, SOFA score, Logistic organ dysfunction Scoring (LODS score) Two groups of patients were scored. Logistic regression analysis was used to analyze the APACHE III score, MODS score, SOFA score, LODS score, blood glucose level, C-reactive protein level and basic disease score for multivariate analysis to evaluate prognostic risk factors. Results The age, APACHE III score, MODS score, SOFA score and LODS score in survival group were significantly lower than those in death group (P <0.05). Logistic regression analysis showed that blood glucose> 7.8 mmol / L, C-reactive protein, basic disease score, APACHE III score, MODS score, LODS score and SOFA score were independent risk factors influencing prognosis of patients. Conclusions APACHE Ⅲ, MODS, SOFA and LODS scores are helpful to predict the prognosis of patients with acute stroke complicated with multiple organ dysfunction syndrome. Hyperglycemia, C - reactive protein and underlying diseases are independent risk factors for prognosis.