动态APACHEⅡ评分在内科急诊ICU中预后评估应用.docVIP

动态APACHEⅡ评分在内科急诊ICU中预后评估应用 　【摘要】 目的 应用急性生理学及慢性健康状况评分Ⅱ（acute physiology and chronic health evaluationⅡ，APACHEⅡ）系统评估急诊内科重症监护病房（intensive care unit，ICU）患者疾病的危重程度、疗效和预后。方法 观察内科急诊ICU共163例重症患者，进行3天动态APACHEⅡ评分及临床对比。结果 死亡47例，APACHEⅡ分值为(24.67±6.93)分；存活116例，APACHEⅡ分值为(15.8±7.33)分，两者差异有非常显著性（t＝4.65，P＜0.01）。其中肺部感染组APACHEⅡ评分最高(25.44±8.46)分，与其他病种组存在组间差异（P＜0.01）。脑血管疾病组病死率最高（37.93%），其3天动态APACHEⅡ评分差异有显著性（P＜0.05）。在第24h内脑血管疾病组的APACHEⅡ评分与心血管疾病组相比差异则无显著性，分别为（16.60±5.08）分和(16.09±8.20)分（t＝0.37，P＞0.05）。预计病死率和实际病死率均与APACHEⅡ分值呈显著正相关。结论 APACHEⅡ评分系统可以较准确预测患者的感染严重性、治疗效果和预后。对于病情有变化且入院时一次性评分不能获得准确预测结果的患者进行动态评分，则更能准确地评估其预后。 【关键词】 急性生理学及慢性健康状况评分Ⅱ；重症监护病房；预后 【Abstract】 Objective To evaluate the significance of the prediction of APACHEⅡscoring system for emergency internal patients in ICU.Methods 163 cases of emergency internal ICU were compared and studied. These data were evaluated with APACHEⅡscoring system for 3 days.Results The scores of the 47 nonsurvivors were significantly higher than those of 113 survivors (24.67±6.93 vs.15.8±7.33，t=4.65，P＜0.01). The patients with pneumonia had a highest APACHEⅡ score (25.44±8.46) than other diseases(P＜0.01).The patients with cerebrovascular diseases have a highest mortality（37.93%）than other groups.A significant difference was found among the 3 days′ scores by with APACHEⅡ(P＜0.05).The scores had positive correlation between actual and predicted mortality.Conclusion APACHEⅡ scoring system can satisfactorily predict and evaluate the severity and the prognosis of infection illness in ICU.we can also predict more accurately the outcomes with the scores of continual APACHEⅡ for 3 days′than the ones of only 1 day′s. 【Key words】 APACHEⅡ；ICU；prognosis 重症监护病房（ICU）是现代医院中重要的抢救单元，进入ICU的危重患者病情复杂，变化疾速，若处理不当或不及时，将产生不良后果；但过于积极的治疗反而会造成医疗资源的浪费。急性生理学及慢性健康状况评分系统——APACHEⅡ是目前临床上重症监护病房应用最广泛、最具权威的危重病病情评价系统。它经对入ICU的患者的病情评定和病死率的预测可以客观地制订和修正医疗护理计划，为提高医疗质量、合理利用医疗资源以及确定最佳出院时机或选择治疗的时间，提供了客观、科学的依据。既可用于单病种患者的比较，也可用于混合病种。笔者总结了我院2004年9月～2005年5月急诊ICU收治的163例内科重症患者的临床资料，运用APACHEⅡ评分系统进