目的 探討膿毒癥患者的病情預后與高密度脂蛋白（HDL）之間的關聯性。 方法 2008年3月1日－2010年2月28日選擇50例嚴重膿毒癥患者（膿毒癥組）和30例非膿毒癥的健康人（對照組），比較兩組急性生理學與慢性健康狀況評分Ⅱ（APACHEⅡ）和HDL水平。 結果 膿毒癥組的HDL水平為（1.10 ± 0.39）mmol/L，對照組HDL水平為（1.61 ± 0.42） mmol/L，兩組差異有統計學意義（t=6.786，P=0.000）。多因素非條件logistic回歸分析顯示，HDL水平（OR=0.877，P=0.025）和APACHEⅡ評分（OR=15.556，P=0.009）是影響膿毒癥患者患病程度的兩個有效獨立因素。 結論 膿毒癥能夠導致患者的脂代謝出現紊亂，HDL水平是評估膿毒癥患病程度的較好指標。
Objective According to characteristics of the wounded, we discussed the key points of Triage Algorithm during the large scale disasters occurring. It will provide some suggestion for establ ishment the triage process, matching with reasonable medical resources on time and making medical care promotion. Method Analysis the data of patients sent to emergency department of West China Hospital in different periods after temblor, and make conclusion on alternation of the triage process. Result A total of 2621 wounded people have been treated in West China Hospital three weeks after earthquake. The severity of patients in a seimic disaster sent to hospital changed as time went on. The percentage of skin and soft tissue injuries and l imbs fractures is 45%. The percentage of crush injury is 4.3%. There are five cases of gas gangrene and none of hospital cross-infection. Conclusion Triage the victims after earthquake dynamically increases the survival rate and decreases the mortal ity and overtriage rate, the key process of triage systems should be modified dynamically with characters alternation of the victims after China Wenchuan earthquake, the rescue level and effect can be made progress.
目的 探討血清降鈣素原（PCT）、C反應蛋白（CRP）與急性生理及慢性健康評分標準Ⅱ（APACHE Ⅱ）評分在轉診肺炎合并膿毒癥患者診斷中的相關性，以尋找更為簡潔、快速判斷其病情嚴重程度的指標。 方法 2009年1月－2010年12月，選取178例轉診肺炎合并膿毒癥患者并進行膿毒癥分級，對其進行血清PCT和CRP測定，并與APACHE Ⅱ評分及預后進行相關性分析。 結果 嚴重膿毒癥組及膿毒性休克組患者血清PCT、CRP水平與APACHE Ⅱ評分較全身炎癥反應綜合征組及膿毒癥組高（P＜0.05）；30 d內死亡的患者其血清PCT、CRP水平及APACHEⅡ評分較存活組明顯增高（P＜0.05）；轉診肺炎合并膿毒癥患者血清PCT與APACHE Ⅱ評分呈正相關（r=0.683，P=0.023），與血清CRP水平呈較弱的正相關（r=0.272，P=0.037）。 結論 對轉院肺炎合并膿毒癥患者進行血清PCT和CRP測定，對病情評估具有一定臨床價值，特別是PCT可作為對轉診肺炎合并膿毒癥患者病情程度判斷的重要指標，為早期干預及治療提供依據，值得臨床推廣應用。