摘要目的 探讨热射病患者入院时APACHE.Ⅱ评分联合DIC评分对死亡的预测价值.方法 收集河北医科大学哈励逊国际和平医院自2013年6月至2017年9月收治的76例热射病患者为研究对象,根据预后将其分为死亡组与存活组.根据患者入院时临床资料及入院时检验结果分别计算APACHE.Ⅱ评分及DIC评分,探讨2个指标联合对预后的价值.结果 76例患者中,死亡23例(30.3％),存活53例(69.7％).死亡组患者入院APACHE.Ⅱ评分和DIC评分分别为26.26±6.48和4.00±1.38,明显高于存活组(APACHE.Ⅱ评分为20.74±4.17,DIC评分为2.28±1.21),差异有统计学意义(P＜0.01).APACHE.Ⅱ评分与DIC评分呈正相关关系(r=0.853,P＜0.01),评分越高死亡率越高.logistic回归分析显示,两项指标能很好地预测死亡.APACHE.Ⅱ评分预测死亡的敏感度和特异度为65.2％和81.1％,DIC评分预测死亡的敏感度和特异度为65.2％和84.9％,APACHE.Ⅱ评分联合DIC评分预测死亡的敏感度和特异度为73.9％和92.5％.结论 入院APACHE.Ⅱ评分及DIC评分在热射病患者早期即明显升高,APACHE.Ⅱ评分联合DIC评分对热射病患者死亡预测价值更高.

abstractsObjective To investigate the predictive values of the acute physiology and chronic health evaluation Ⅱ (APACHE.Ⅱ) score and disseminated intravascular coagulation (DIC) score on death in patients with heat stroke.Methods A total of 76 patients with heat stroke who were treated in Emergency Department of Harrison International Peace Hospital from June 2013 to September 2017 were studied.According to the outcome of patients,we distributed the patients to death group and survival group.APACHE.Ⅱ score and DIC score were calculated according to the clinical data and the test resuhs at admission.Evaluate the correlation between the two indicators associated with death.Results There were 76 patients,with 23 deaths(30.3％) and 53 survivors(69.7％).The APACHE-Ⅱ score and DIC score were 26.26±6.48 and 4.00±1.38 in the death group.significantly higher than 20.74±4.17 and 2.28± 1.21 in the survival group,and there were significant difference (P＜ 0.01).The APACHE.Ⅱ score was positively correlated with the DIC score,and the higher the score,the higher the mortality rate.Both indicators are significant for the Logitic regression analysis of death(P＜0.01).The sensitivity and specificity of the APACHE.Ⅱ score were 65.2％ and 81.1％ in prediction of mortality,The sensitivity and specificity of DIC score were 65.2％ and 84.9％ in prediction of mortality.The specificity of the APACHE Ⅱ score plus DIC score were higher than that of single APACHE.Ⅱ score or DIC score in prediction of mortality (P＜0.05).Conclusion The APACHE.Ⅱ score and DIC score are significantly increased in the early stage of the patients with heat stroke,and the APACHE.Ⅱ score combined with DIC score may improve the value in prediction of mortality with heat stroke.