改良急性生理学与慢性健康状况评分系统Ⅱ评分在急诊危重患者中的建立和应用  

The use and establishment of modified acute physiology and chronic health evaluation Ⅱ score in emergency patients

作　　者：叶舟[1] 陶玲[1] 范兆普[1] 吴锦萍[1] 王英[1] 

机构地区：[1]新疆克拉玛依市中心医院急救中心,834000

出　　处：《中国危重病急救医学》2008年第8期476-478,共3页Chinese Critical Care Medicine

基　　金：新疆石油管理局科研基金资助项目（JK060901）

摘　　要：目的将急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）进行改良，使之更简便、实用。方法回顾2003年1月-2005年10月全院重症加强治疗病房（IcU）死亡患者，选择各项生理指标数据齐全、且符合改良APACHEⅡ评分标准者为试验组（153例），对照组选择同期监护室生存患者进行1：1配对，以患者24h内最差生理指标为标准并填表，然后将患者是否死亡与改良APACHEⅡ评分进行拟合检验及建立回归模型，将其应用于2006年1—10月的急诊抢救患者，评价其预报准确性。结果应用Lemeshow—Hosmer拟合优度检验，预计死亡与实际死亡情况比较，X^2=8．853，P=0．335，拟合度良好。改良APACHEⅡ评分以界点16分为预报值，急诊抢救室患者现场预测死亡的敏感度为86．8％，特异性为81．6％，准确性为81．8％。改良APACHEⅡ评分低者缓解回家及留观的比例较高；随分数增高，入院、死亡的比例也随之增高。结论APACHEⅡ评分方便、实用于急诊领域。Objective To simplify the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score to make it more suitable for emergency patients. Methods Medical records of all the dead patients in the intensive care unit （ICU） from January 2003 to October 2005 were retrospectively analyzed. Those dead patients whose clinical data were completed for study were chosen as the experimental group （153 cases）. Patients who survived in the same ICU at the same period were chosen as cohort for comparison. The worst scores within 24 hours of admission were selected for comparison between survivors and non-survivors to establish the modified APACHE Ⅱ by linear regression. Then the new score was tested in the emergency patients who needed medical care from January to October 2006, and the accuracy of the prognostic value was evaluated. Results Tested by the Lemeshow-Hosmer C-statistic and calibration curve analysis, the modified APACHE Ⅱ score showed a good clustering data and the high calibration of the potential death of the nonsurvivors （X^2= 8. 853, P= 0. 335）. If 16 being the forecasting point, the modified APACHE Ⅱ score showed that sensitivity of the model in forecasting the dead patients from the emergency patients was 86.8% with an exclusivity of 81.6% and accuracy of 81.8%. The scores of the modified APACHE Ⅱ paralleled with severity of the patients conditions, suggesting that the patients with lower scores were inclining to be discharged early or with a shorter period of hospitalization, while those with higher scores, the possibility of prolonged hospitalization or even death might ensue. In another words, the higher scores the higher risk of death. Conclusion The modified APACHE Ⅱ score could be conveniently used in emergency patients with high reliability.

关 键 词：急性生理学与慢性健康状况评分系统Ⅱ 急诊患者 改良评分 

分 类 号：R686[医药卫生—骨科学]