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目的 采用感染相关的器官衰竭评分系统 (SOFA)描述多器官功能障碍综合征 (MODS)的临床特点。方法 回顾了 5家医院的加强医疗病房 (ICU) 1990至 1996年间收治的 36 6例MODS患者 ,并进行SOFA评分。结果 最高SOFA评分、SOFA评分差值以及入ICU时的SOFA评分与患者的住院病死率呈较好的相关关系 ,ROC曲线下的面积分别为 0 819,0 75 0和 0 6 16。没有器官衰竭的患者SOFA评分为 3 7± 1 2 ,病死率 2 1 7% ,6个器官衰竭的患者SOFA评分为 2 0 2± 1 4,病死率77 8%。呼吸系统达到最高评分的时间最短 (1 41d) ,循环系统所需时间最长 (4 89d)。Logistic回归模型显示 ,中枢神经系统评分对预后的影响最大 (OR 1 75 ) ,之后是肾脏 (OR 1 42 ) ,循环系统 (OR1 38) ,凝血 (OR 1 34)和呼吸系统 (OR 1 17)。肝脏对患者的预后没有影响 (OR 0 99)。结论 最高SOFA评分和SOFA评分差值可以较好地反映患者在ICU住院期间MODS的发生及预后情况。
Objective To describe the clinical features of multiple organ dysfunction syndrome (MODS) using the infection related organ failure score system (SOFA). Methods 366 MODS patients admitted to intensive care units (ICUs) in five hospitals between 1990 and 1996 were reviewed and SOFA scores were assessed. Results The highest SOFA score, SOFA score difference and SOFA score at entry into the ICU correlated well with the inpatient mortality rate of the patients. The areas under the ROC curve were 0 819,0 75 0 and 0 6 16, respectively. In patients without organ failure, the SOFA score was 37 ± 1 2 and the case fatality rate was 21.7%. The SOFA score of 6 organ failure patients was 202 ± 14 and the case fatality rate was 77.8%. Respiratory system to achieve the highest score the shortest time (114d), the circulatory system takes the longest (4 89d). The Logistic regression model showed that the central nervous system score had the greatest impact on prognosis (OR 1 75), followed by the kidney (OR 1 42), circulatory system (OR 1 38), coagulation (1 34) and respiratory system (OR 1 17) . The liver has no effect on the patient’s prognosis (OR 0 99). Conclusion The difference between the highest SOFA score and the SOFA score can better reflect the occurrence and prognosis of MODS during hospitalization in ICU.