APACHEⅡ评分在CBP治疗MODS时机选择中的应用研究  

APPLICATION STUDY OF APACHE Ⅱ IN MODS PATIENTS TREATED WITH CBP

作　　者：孟新科[1] 郑晓英[1] 吴华雄[1] 杨径[1] 魏刚[1] 陈伟峰[1] 刘德红[1] 

机构地区：[1]广东省深圳市第二人民医院急诊科,广东深圳518035

出　　处：《实用临床医药杂志》2005年第9期86-88,共3页Journal of Clinical Medicine in Practice

基　　金：广东省深圳市科技计划项目(200304086)

摘　　要：目的探讨APACHE Ⅱ评分在指导选择连续性血液净化(CBP)治疗MODS最佳时机中的作用和价值.方法按APACHE Ⅱ评分不同,将136例MODS患者分别在APACHE Ⅱ评分<15分;15～25分;>25分3个分数段内分为CBP治疗组和非CBP治疗组.在不同APACHE Ⅱ评分分数段内分别比较是否行CBP治疗的两组患者的病死率、住院时间、医疗费用等的差异.结果 APACHE Ⅱ评分<15分时,CBP治疗组和非CBP治疗组患者均无患者死亡,医疗费用也无显著差异;但CBP治疗组患者住院时间明显短于非CBP治疗组(P<0.05).APACHE Ⅱ评分15～25分时,CBP治疗组患者病死率、住院时间明显低于非CBP治疗组(P<0.05,P<0.01),2组间的医疗费用则无显著性差异.APACHE Ⅱ评分>25分时,2组患者病死率无显著差异,但CBP治疗组住院时间、医疗费用明显高于非CBP治疗组(P<0.05,P<0.01).结论 APACHE Ⅱ评分为15～25分是CBP治疗MODS患者的最佳时机,可以产生最佳的'效-价'比.APACHE Ⅱ评分可以作为确定MODS患者是否选择进行CBP治疗,以及何时进行CBP治疗的指标之一.Objective To explore the value of acute physiology and chronic health evaluation （APACHE） Ⅱ score in definition optimal opportunity of multiple organ dysfunction syndrome （MODS） treated with continue blood purification （CBP）. Methods All of the 136 MODS patients were divided into three groups （APACHE Ⅱ 〈15; APACHE Ⅱ 15 to 25; APACHE Ⅱ 〉25） according to different APACHE Ⅱ score. In each of APACHE Ⅱ group, patients were divided into CBP and non-CBP group further. Mobility, in-hosphal times and costs were compared between CBP and non-CBP group in three APACHE Ⅱ groups respectively. Results When APACHE Ⅱ score 〈 15, there had no patients died in CBP and non-CBP group; there have no significantly difference between CBP and non ／｜ CBP group in costs, no the other hand in in-hospital times. The in-hospital times of CBP group was significantly shorter than that of non-CCBP group [ （14.4 ± 7.2） d VS （23.6±9.3） d, P=0.048）]. When APACHE Ⅱ score is inl5 to 25, mobility of CBP group was significantly lower than that of non-CCBP group （14.3% VS 42.1%, P = 0. 018）; in-hospital times of CBP group was significantly shorter than that of non-CCBP group [（21.7 ± 7.9） d VS （42.1 ±21.3） d, P = 0. 008）]too; the costs have no significantly difference between CBP and non-CBP group. When APACHE Ⅱ score〉25, there have no significantly difference between CBP and non - CBP group in mobility ; but in -hospital times of CBP group was significantly longer than that of non- CCBP group （ 4 4.8 ± 18.4 VS 31.4 ± 2 0.7 d, P = 0.016 ） and cost of CBP group was significantly more than that of non-CCBP group [（49 181.0 ± 45 633.2） VS （36 149.1 ± 22728.9） yuan, P = 0. 006） ]. Conclusion 15 to 25 of APACHE II score are optimal opportunity of MODS treated with CBP. APACHE II score may be selected as index of MODS treated with CBP.

关 键 词：APACHE Ⅱ评分 连续性血液净化治疗(CBP) 多器官功能衰竭综合征(MODS) 

分 类 号：R459.5[医药卫生—治疗学]