APACHEⅡ系统在外科监护室的应用  

Performance of APACHEⅡ Models in Surgical Intensive Care Unit

作　　者：张鸿[1] 诸杜明[1] 薛张纲[1] 罗剑峰[2] 蒋豪[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032 [2]复旦大学公共卫生学院卫生统计与社会医学教研室,上海200032

出　　处：《复旦学报（医学版）》2004年第4期417-420,共4页Fudan University Journal of Medical Sciences

基　　金：上海市医学领先专业重点学科 (993 0 2 7)资助项目

摘　　要：目的　评价急性生理学和慢性健康状况评估 (APACHE)Ⅱ评分系统在单中心外科监护室 3年的应用情况。方法　对本院外科监护室连续 3年符合标准的 831例患者 ,收集与APACHEⅡ评分系统相关的病例资料 ,计算预计死亡危险度 ,并与实际住院病死率比较 (标化死亡比 )。分辨度的评价应用四格分类表和受试者操作特性曲线 ;校准度的评价采用拟合优度检验和校准曲线 ;按年龄、入住类型、停留时间分层 ,评估模型的拟合一致性。结果　整体住院病死率为 2 0 .1% ,标化死亡比达 1.75 ,95 %可信区间为 1.5 0～ 2 .0 4。以 5 0 %预计死亡危险度为截断点 ,总体正确分类率达 81.7% ,ROC曲线下面积达 0 .878,提示模型分辨度良好 ;Hosmer Lemeshow拟合优度检验 (H2 =96 .7,P <0 .0 1)和校准曲线提示校准度较差。急诊术后和短期停留患者的分辨度和校准度都较满意。结论　APACHEⅡ评分系统并不完全适用于整个研究人群 ,临床应用应谨慎 ;同时应当改进和提高外科监护室的整体诊治水平。Purpose To validate the severity scoring system of acute physiology and chronic health evalua tion (APACHEⅡ) in a single center surgical intensive care unit (SICU) population for three years. Methods Data were collected in SICU over 3 years on 831 consecutively qualified admitted patients regarding APACHEⅡ.Predicted hospital mortality and standardized mortality ratio was calculated.Discrimination was tested using classification matrices and receiver operating characteristic (ROC) curves;Calibration was tested using the Hosmer Lemeshow goodness of fit tests and calibration curves;The uniformity of fit was evaluated in age,type of admission and length of stay (LOS) subgroups. Results For the SICU population as a whole,the hospital mortality was 20.1%,and the risk adjusted standardized mortality ratio (SMR) was 1.75 (95% confidence intervals,1.50-2.04).The total correct classification rate was 81.7% at the predicted risk of 50% and the area under the ROC curve was 0.878 suggest a good discrimination of the model.The Hosmer Lemeshow goodness of fit tests ( H 2=96.7,P <0.01) and calibration curves showed a poor calibration.The discrimination and calibration were good in the subgroup patients of the postemergency surgery and the short LOS. Conclusions The severity scoring system of APACHEⅡdid not fit the study population as a whole,although it really fitted some subgroup patients.The clinical application of this model should be cautious.Meanwhile,we should further improve our performance of SICU.

关 键 词：APACHEⅡ系统 外科监护室 临床应用 危重病评分 

分 类 号：R195[医药卫生—卫生统计学]