本文選題：疾病嚴(yán)重程度評(píng)分　切入點(diǎn)：急性生理與慢性健康評(píng)分　出處：《南華大學(xué)》2014年碩士論文

【摘要】：目的：通過對(duì)重癥病房（ICU）重癥患者胃腸功能狀態(tài)與預(yù)后相關(guān)性進(jìn)行分析，探討胃腸功能障礙評(píng)分在危重患者中的應(yīng)用價(jià)值。對(duì)象與方法：收集從2013年1月1日至2013年7月1日在郴州市第一人民醫(yī)院ICU住院時(shí)間超過24小時(shí)的年齡大于18歲的成年患者465例的性別、年齡、入住ICU的主要診斷、是否急診手術(shù)、血小板計(jì)數(shù)、膽紅素水平、血清肌酐水平、尿量、以及APACHEⅡ評(píng)分、首日SOFA評(píng)分、既往慢性疾病病史、是否進(jìn)行機(jī)械通氣、ICU住院天數(shù)、醫(yī)院住院天數(shù)、機(jī)械通氣天數(shù)、前三日GIF評(píng)分、胃腸營(yíng)養(yǎng)入量、住院死亡率、ICU獲得性感染等臨床資料。使用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)。結(jié)果：ICU患者首日即發(fā)生胃腸功能障礙的患者比例高達(dá)84.9%；以患者是否死亡進(jìn)行分組分析，兩組患者首日GIF評(píng)分及前三日平均GIF評(píng)分有統(tǒng)計(jì)學(xué)意義，同時(shí)提示預(yù)后差的患者胃腸功能狀態(tài)也差；不同病因入住ICU患者胃腸功能障礙發(fā)生存在差異，無論是在首日的GIF評(píng)分還是前三日GIF評(píng)分平均值因膿毒癥入住ICU患者與因循環(huán)系統(tǒng)問題、呼吸系統(tǒng)問題、多發(fā)傷及神經(jīng)系統(tǒng)問題等入住ICU的患者比較無統(tǒng)計(jì)學(xué)意義（P0.05），但這幾類患者與因胃腸功能問題入住ICU患者GIF評(píng)分比較有統(tǒng)計(jì)學(xué)意義（P0.05）；非胃腸系統(tǒng)疾病入住ICU的患者首日是否存在胃腸功能障礙進(jìn)行分組分析，結(jié)果提示在非胃腸系統(tǒng)疾病入住ICU的患者中提示疾病嚴(yán)重程度的血壓水平、血糖水平、基礎(chǔ)疾病評(píng)分、APACHEII評(píng)分、首日SOFA評(píng)分均無統(tǒng)計(jì)學(xué)意義(p0.05)，而提示預(yù)后的指標(biāo)ICU住院天數(shù)、醫(yī)院住院天數(shù)及死亡率方面存在統(tǒng)計(jì)學(xué)意義（p0.05）；對(duì)入ICU首日即存在胃腸功能障礙的患者進(jìn)行原發(fā)胃腸功能障礙及繼發(fā)胃腸功能障礙分組。原發(fā)胃腸功能障礙為入住ICU主因胃腸系統(tǒng)疾病，繼發(fā)胃腸功能障礙為入住ICU主因?yàn)榉挝改c系統(tǒng)疾病。結(jié)果提示在入住ICU患者是否因胃腸系統(tǒng)疾病在疾病嚴(yán)重程度的最低血壓水平、尿素氮水平、血小板水平、基礎(chǔ)疾病評(píng)分、APACHEII評(píng)分、首日SOFA評(píng)分、第一天GIF評(píng)分及前三日平均GIF評(píng)分均有統(tǒng)計(jì)學(xué)意義(p0.05)，而提示預(yù)后的指標(biāo)ICU住院天數(shù)、醫(yī)院住院天數(shù)、機(jī)械通氣天數(shù)存在統(tǒng)計(jì)學(xué)意義（p0.05），但是死亡率方面無統(tǒng)計(jì)學(xué)意義（P0.05）；而以首日是否發(fā)生胃腸營(yíng)養(yǎng)不耐受（food intolerance FI）進(jìn)行分組分析提示首日FI并不能準(zhǔn)確反映患者的病情嚴(yán)重程度；而前三日平均GIF評(píng)分提示前三日總體FI時(shí)患者病情更嚴(yán)重。而對(duì)患者首日是否存在腹腔高壓（intra-abdominal hypertension IAH）或者腹腔間室綜合征（abdominalcompartment syndrome ACS）進(jìn)行分組分析，提示IAH組患者PACHEII評(píng)分、SOFA評(píng)分、死亡率顯著高于無IAH組。對(duì)APACHEII評(píng)分、SOFA評(píng)分及平均GIF評(píng)分進(jìn)行Logistic回歸分析提示平均GIF評(píng)分同APACHEII評(píng)分及SOFA評(píng)分均是患者死亡的危險(xiǎn)因素；對(duì)APACHEII評(píng)分、SOFA評(píng)分及平均GIF評(píng)分作受試者生存工作曲線分析提示在判別患者死亡方面GIF評(píng)分具備APACHEII評(píng)分及SOFA評(píng)分的同等的校驗(yàn)力。結(jié)論：重癥患者胃腸功能障礙發(fā)生率高，不同疾病類型發(fā)生胃腸功能障礙嚴(yán)重程度不一致，，使用GIF評(píng)分進(jìn)行患者病情嚴(yán)重程度評(píng)估應(yīng)當(dāng)注意患者的疾病類型，首日及前三日平均的GIF評(píng)分高提示患者的預(yù)后差。前三日總體評(píng)估存在FI患者病情更嚴(yán)重。首日即存在IAH患者預(yù)后差。高的平均GIF分值是患者死亡危險(xiǎn)因素。平均GIF評(píng)分在判別患者死亡方面具備APACHEII評(píng)分及SOFA評(píng)分的同等的校驗(yàn)力。
[Abstract]:Objective : To analyze the relationship between gastrointestinal function status and prognosis in intensive care unit ( ICU ) , and to explore the application value of gastrointestinal dysfunction score in critically ill patients .
Group analysis was carried out on whether the patient died or not , the first GIF score and the average GIF score of the first three days were statistically significant in both groups , and the difference of gastrointestinal function was also suggested in patients with poor prognosis .
There was a difference in gastrointestinal dysfunction in ICU patients with different etiologies , whether on the first day GIF score or the first three days , the average of GIF score was not statistically significant ( P0.05 ) . However , there was a significant difference between these patients and the GIF score of ICU patients due to gastrointestinal function ( P0.05 ) .
There was no statistical significance ( p . 05 ) in the patients with non - gastrointestinal system disease admitted to ICU on the first day . The results suggested that in patients with non - gastrointestinal system disease admitted to ICU , there was no statistical significance ( p . 05 ) for the severity of disease , blood sugar level , basic disease score , APACHEII score and SOFA score of the first day ( p . 05 ) .
Results : In ICU patients , there was statistical significance ( p < 0.05 ) for the most low blood pressure level , urea nitrogen level , platelet level , basic disease score , APACHEII score , first SOFA score , first day GIF score and the first three days in ICU patients .
It was suggested that the first day of FI did not accurately reflect the severity of the patient ' s condition .
鑰屽墠涓夋棩騫沖潎GIF璇勫垎鎻愮ず鍓嶄笁鏃ユ

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