APACHEⅡ与TISS-28评分系统在慢性阻塞性肺疾病急性加重呼吸衰竭治疗中的预测价值  

The predictive value of APACHEⅡ and TISS-28 in the treatment to respiratory failure in acute exacerbation of chronic obstructive pulmonary disease

作　　者：徐喜媛[1] 姚易凯[2] 杨敬平[1] 

机构地区：[1]内蒙古医学院第三附属医院呼吸与危重症医学科内蒙古自治区呼吸与危重症研究所,内蒙古包头014010 [2]包头医学院第一附属医院耳鼻喉科,内蒙古包头014010

出　　处：《中国实用内科杂志》2009年第12期1121-1123,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的以分值量化的形式评价慢性阻塞性肺疾病(COPD)急性加重期合并呼吸衰竭的治疗手段的选择。方法选择2006年12月至2008年6月内蒙古医学院第三附属医院收治的156例COPD急性加重期合并呼吸衰竭患者依据入内科重症监护室(MICU)时各生理学指标的最差值所计算出的急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)分值对入选病例进行分组,分为吸氧组和双水平无创正压通气(BiPAP)组。依据入MICU后24h内各生理学指标的最差值所计算出的APACHEⅡ和治疗强度评分(TISS-28)分值对入选病例进行再次分组,分为吸氧有效组、BiPAP有效组和有创通气组。分别统计各组患者的APACHEⅡ和TISS-28分值范围、住院时间。结果有创通气组的APACHEⅡ评分(27.44±6.79)和TISS-28分值(28.22±7.90)显著高于其他各组(P均<0.01)。吸氧有效组与BiPAP有效组住MICU时间差异无统计学意义(P>0.05),有创通气组与BiPAP有效组住MICU时间有明显差异(P<0.01)。结论COPD急性加重期患者可根据病情严重程度(APACHEⅡ评分)及治疗强度(TISS-28评分)来选择相应的治疗手段。Objective Estimating the treatment to respiratory failure in acute exacerbation of chronic obstructive pulmonary disease by scores in the form of quantitative assessment. Methods 156 patients with chronic obstructive pulmonary disease with acute exacerbation of respiratory failure in patients in the medical intensive care unit based on the worst value of the calculated APACHE Ⅱ score were grouped, divided into groups and pairs of oxygen the level of non-invasive positive pressure ventilation group. Based on the worst values calculated by the APACHE Ⅱ and TISS-28 score within 24 h after admission into MICU selected cases is re-grouped into an effective group of oxygen, BiPAP effective group and invasive ventilation group. Statistics separately for each group of patients with APACHE Ⅱ score and TISS-28 score range,length of stay. Results The invasive ventilation group APACHE Ⅱ score （ 27.44 ± 6. 79 ） and TISS-28 score （ 28. 22 ±7. 90 ） was significantly higher than the other groups （P 〈 0. 01 ）. The effective group of oxygen and effective group MICU time of BiPAP have no significant difference（ P 〉 0. 05 ） ,invasive ventilation group and effective group MICU hours of BiPAP have significant difference （ P 〈 0. 01 ）. Conclusion Patients with acute exacerbation of COPD, we can refer to disease severity （ APACHE Ⅱ score） and treatment intensity（ TISS-28 score） to select the appropriate treatments.

关 键 词：急性生理功能和慢性健康状况评分系统Ⅱ 治疗强度评分 慢性阻塞性肺疾病急性加重 呼吸衰竭 

分 类 号：R5[医药卫生—内科学]