APACHE Ⅳ和APACHE Ⅱ预测危重症患者预后的比较性研究  

Comparison of APACHE Ⅳ with APACHE Ⅱ in Predicting Prognosis of Intensive Care Unit

作　　者：李淑娴[1] 翁慧纯[2] 张淇钏[1] 方喜斌[1] 

机构地区：[1]汕头市中心医院重症监护科,广东汕头515031 [2]汕头市中心医院内科,广东汕头515031

出　　处：《现代生物医学进展》2012年第31期6076-6079,共4页Progress in Modern Biomedicine

摘　　要：目的:比较不同版本的急性生理和慢性健康评分(Acute Physiology And Chronic Health Evaluation,APACHE)(APACHE Ⅳ和APACHE Ⅱ)对于成人危重症患者预后评估的应用价值。方法:收集2011年1月至10月入住我院重症监护病房患者的临床资料,分别计算其入ICU24小时内的APACHE Ⅳ和APACHE Ⅱ评分,并计算其各自预测病死率,通过标准化死亡率(StandardizedMortality Ratios,SMR)来比较这两个评分系统对危重症患者预后评估的准确性。结果:本研究共纳入184例患者,死亡率为41.8%。APACHE Ⅱ得分为25±8分,预测死亡率为53.31%;APACHE Ⅳ得分为93±24分,预测死亡率为30.76%。APACHEⅡ预测死亡率比实际死亡率高(SMR为0.78,95%CI 0.614～0.972);APACHEⅣ预测死亡率比实际死亡率低(SMR=1.35,95%CI1.066～1.688)。但二者对于危重症患者死亡率的预测没有统计学差异(P>0.05)。结论:APACHE Ⅱ和APACHE Ⅳ对于危重症患者死亡率预测准确性高;与APACHE Ⅱ相比,APACHE Ⅳ无表现出更为优越的性能,二者之间的差异不存在统计学意义。Objective： To evaluate and compare the performance and valuation of different versions of Acute Physiology And Chronic Health Evaluation （APACHE） scores （APACHE II and APACHE IV） in Intensive Care Unit. Methods： Retrospectively we collected the medical records of 184 patients admitted to intensive care unit of Shantou Central Hospital between January to October in 2011. We calculated the APACHE II and APACHE IV scores when patients admitted in ICU in the first 24 hours, and calculated their Predicted Hospital Mortality. Their performance was compared by Standardized Mortality Ratios （SMR）. Results： A total of 184 patients consecutively admitted to the study. The overall mortality rates were 41.8%.APACHE II scores were 25± 8, predicted mortality rates were 53.31%. APACHE IV scores were 93± 24, predicted mortality rates were 30.76%. The predicted mortality rates of APACHE II was higher than observed （SMR 0.78, 95%CI 0.614-0.972）; and the predicted mortality rates of APACHE IV was lower than observed （SMR 1.35, 95%CI 1.066-1.688）. But there was no significant difference between them （P 〉0.05）. Conclusions： The APACHE II and APACHE IV both had high accuracy in predictting mortality rates of ICU patients. However, APACHE IV did not perform better than APACHE II. Nevertheless, there was no significant difference between them.

关 键 词：急性生理和慢性健康评分系统 重症监护病房 预测死亡率 标准化死亡率 

分 类 号：R459.7[医药卫生—急诊医学]