摘要
目的探讨急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)对外科重症监护病房(SICU)中多器官功能障碍综合征(MODS)病情危重程度及预后判断的应用价值。方法回顾性调查2003年1月至2006年6月该院SICU收治的41例MODS患者临床资料,计算各自APACHEⅡ评分及预计病死率,并进行病情评估。结果 41例MODS患者的APACHEⅡ评分范围为5.32～48.06分,平均(26.62±6.95)分;生存13例评分为(19.85±8.17)分,死亡28例评分为(29.77±3.08)分,差异有统计学意义(P<0.001)。APACHEⅡ评分与实际病死率间呈显著正相关,差异有统计学意义(r=0.90,P<0.005)。APACHEⅡ评分与预计病死率间呈显著正相关,差异有统计学意义(r=0.96,P<0.001)。APACHEⅡ评分值以5分增加,实际与预计病死率也增加,且APACHEⅡ评分大于或等于25分时,实际与预计病死率也明显升高,提示预后较差。在APACHEⅡ评分低分值段敏感性偏低,预计病死率偏低。结论 APACHEⅡ评分系统可较好地评价SICU中MODS患者病情危重程度及判断预后,可客观地评价SICU的医疗及监护质量,为合理利用SICU资源提供参考,但APACHEⅡ评分对低分值段MODS患者病死率有低估倾向。
Objective To investigate the value of acute physiology and chronic health evaluationⅡ（APACHEⅡ） scoring system in evaluating multiple organ dysfunction syndrome（MODS） patients severity of surgical intensive care unit（SICU）.Methods Forty-one MODS patients admitted to SICU from January 2003 to June 2006 were studied retrospectively,then APACHEⅡscores were calculated,and prediction of hospital mortality of MODS patients was evaluated.Results APACHE Ⅱ scores of these patients were in the range of 5.32-48.06,average（26.62±6.95）,with average score of（19.85±8.17）for 13 survivors and（29.77±3.08）for nonsurvivors.The difference between these two groups of patients was significant（P0.001）.There was a significant correlation between APACHEⅡ score and actua1 mortality（r=0.90,P0.005）,and predicted mortality（r=0.96,P0.001）.Actual and predicted mortality increased along with the increase in APACHEⅡ scores by 5 scores.When the scores was higher than 25,both actua1 and predicted mortality increased more significantly.These suggested poorer prognosis.The sensitivity and predicted mortality were low at low APACHEⅡscore.Conclusion APACHEⅡ score system can be used to evaluate the severity,predict the prognosis of MODS patients in SICU,and survey the quality of medical care.On the basis of APACHEⅡscore system,SICU′S resource can be used rationally,but it has a trend to underestimate the hospital death rate of low APACHEⅡscore MODS patients.
出处
《重庆医学》
CAS
CSCD
北大核心
2010年第10期1193-1195,共3页
Chongqing medicine
