中国实用外科杂志

中国实用外科杂志

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急性胃肠损伤分级对疾病严重程度及预后评估价值研究（附296例报告）

朱承睿，栾正刚，尹晓晗，张芳晓，陈铭铭，张晓娟，章志丹，马晓春   

  1. 中国医科大学附属第一医院重症医学科，辽宁沈阳 110001
  • 出版日期:2015-05-01 发布日期:2015-04-28

  • Online:2015-05-01 Published:2015-04-28

摘要：

目的    探讨急性胃肠损伤（AGI）分级与疾病严重程度及病人预后的关系。方法    回顾性分析2013年1-9月中国医科大学附属第一医院重症医学科（ICU）收治的296例重症病人资料，对不同AGI分级病人的发病原因、APACHE Ⅱ评分、SOFA评分、并发症发生及预后情况等进行统计分析。结果    296例病人中共289例（97.6%）发生AGI，其中以AGI Ⅰ、 Ⅱ级为主；原发AGI占67.8 %，继发AGI占32.2%；原发AGI分级高于继发AGI，差异有统计学意义（P<0.05）。不同AGI分级病人APACHE Ⅱ及SOFA评分差异有统计学意义（P=0.015、0.003），AGI Ⅲ、Ⅳ级病人APACHEⅡ评分高于AGIⅠ、Ⅱ级，AGI Ⅳ级SOFA评分高于其他（P<0.05）。不同AGI分级病人28 d病死率及多器官功能障碍综合征发生率差异有统计学意义（P<0.05）；两两比较结果显示，除AGIⅠ、Ⅱ级间比较外，其余组间差异均有统计学意义（P<0.05）。发生严重AGI时间多在入ICU早期，AGI Ⅲ、Ⅳ级病人常见临床病因为严重腹腔感染。结论    重症病人AGI发生率较高，多数以轻度（Ⅰ、Ⅱ级）AGI为主，且轻度与重度（Ⅲ、Ⅳ级）AGI病人的病情严重程度及预后存在明显差异。

关键词: 急性胃肠损伤, 胃肠道功能, 急性生理功能和慢性健康状况评分系统, 序贯器官衰竭评估

Abstract:

Evaluation of the severity and prognosis of ICU patients with AGI grading system and its clinical significance：A report of 296 patients        ZHU Cheng-rui，LUAN Zheng-gang，YIN Xiao-han，et al. Intensive Care Unit，the First Affiliated Hospital of China Medical University，Shenyang 110001，China
Corresponding author：MA Xiao-chun，E-mail：xcma2972@sina.com
Abstract    Objective    To discuss the relationships of the acute gastrointestinal injury (AGI) grades，the severity and the prognosis of the patients. Methods    The AGI grades and other clinical data of 296 critical patients admitted from January 2013 to September 2013 in ICU of the First Affiliated Hospital of China Medical University were studied retrospectively. The cause of disease, APACHE Ⅱ score，SOFA score, complications and prognosis among different AGI grades were analyzed statistically. Results    Among 296 patients, 289 patients （97.6%） had AGI. AGI gradeⅠ(136 cases)and AGI grade Ⅱ（118 cases）were the main. Among all the AGI patients, primary AGI accounted for 67.8%，secondary AGI accounted for 32.2%，primary AGI was more serious than secondary AGI （P=0.000）. There were statistically significant differences of APACHE Ⅱ，SOFA score among different AGI grades（P=0.015，0.003）. APACHE Ⅱ scores of AGI grade Ⅲ and Ⅳ were higher than AGI grade Ⅰand Ⅱ, the AGI grade Ⅳ SOFA scores were higher than other AGI grades（P<0.05）. There was no difference in the 28 days mortality rate and the incidence of MODS of AGI grade Ⅰ and Ⅱ，but there were differences of all other AGI grades (all P<0.05). The occasion of severe acute gastrointestinal damages was almost in early time of patients adopted to ICU，and the common cause of AGI grade Ⅲ and Ⅳ was severe abdominal infection. Conclusion    The AGI is extremely common in critical patient，but most of AGI in ICU is mild. There are statistically differences in severity and prognosis between mild AGI（grade Ⅰ and Ⅱ） and severe AGI（grade Ⅲ and Ⅳ）.

Key words: acute gastrointestinal injury（AGI）；gastrointestinal function；APACHE Ⅱ, SOFA