APACHEⅡ评分用于失血性休克患者急诊手术前评估的可行性研究  

Feasibility study of APACHEⅡ score to assess the patients with hemorrhagic shock before operation

作　　者：刘德行[1] 张秋英[1] 张亦南[1] 朱宇航[1] 朱昭琼[1] 

机构地区：[1]遵义医学院附属医院麻醉科,贵州遵义563000

出　　处：《中国急救医学》2015年第3期238-242,共5页Chinese Journal of Critical Care Medicine

基　　金：卫生行业科研专项项目（201002005）;遵义市科技计划项目[遵市科合社字（201475号）]

摘　　要：目的：观察APACHEⅡ评分用于失血性休克患者急诊手术前评估的可行性。方法选择2013－10-2014－06行急诊手术的失血性休克患者60例，术前依据APACHEⅡ评分将0-9分为低分组（L组）及≥10分为高分组（H组）；记录患者入院（T0）、麻醉前（T1）及出室前（ T2）的心率（ HR）、动脉血压（ ABP）、体温（ T）及血红蛋白（ Hb）含量；记录麻醉时间、手术时间、术中补液、术中用血情况及估计失血量等手术实施情况。结果研究剔除6例，共计54例正式纳入并进行数据分析，在T0、T1时，H组HR高于L组，SBP、DBP及T低于L组（ P＜0．01或P＜0．05）；在T0时两组Hb比较差异无统计学意义，而在T1时H组Hb明显低于L组（ P＜0．01）；两组术中用血量比较，H组围术期修正自体血用量多于L组、异体RBC用量多于L组、异体血输注率高于L组，RBC总量明显多于 L 组，估计失血量明显多于 L 组（ P ＜0．01或 P ＜0．05）。结论APACHEⅡ评分用于失血性休克患者急诊术前评估确实可行，具有临床指导意义和研究潜力，值得推广。Objective To observe the feasibility of APACHEⅡscore on preoperative evaluation of emergency surgery in patients with hemorrhagic shock.Methods Sixty cases of patients with hemorrhagic shock who were undergone emergency surgery from October 2013 to June 2014 were enrolled in this study, and were divided into Group L （0-9 points） and Group H （≥10 points） according to the preoperative APACHEⅡscore.Heart rate （ HR） , arterial blood pressure （ ABP） , body temperature （ T） and hemoglobin （ Hb） level were recorded respectively at hospitalization （ T0 ） , before anesthesia （ T1 ） and before leaving the operating room （ T2 ）;anesthesia time, operation time, intraoperative fluid infusion, intraoperative fluid infusion and estimated blood loss, etc.were also recorded.Results Six cases were excluded.A total of 54 cases were included in the data analysis.At T0 and T1 , HR was higher in Group H than Group L, while SBP, DBP, and T were lower in Group L （ P〈0.01 or P〈0.05）.At T0, no statistical difference was found in term of Hb between the groups, however, Hb was significantly lower in Group H compared with Group L at T1（P〈0.01）.Intraoperative blood transfusion were compared.Perioperative autologous blood correction and heterogenous RBC amount were larger in Group H than Group L.Heterogenous blood infusion rate was higher than Group L.Total amount of RBC and estimated blood loss were significantly higher than Group L （P〈0.01 or P〈0.05）.Conclusion APACHEⅡscore is feasible to evaluate patients with hemorrhagic shock before emergency surgery.It is of strong clinical guiding significance and clinical research potential, which is worth promoting.

关 键 词：APACHEⅡ评分 失血性休克 急诊手术 术前评估 

分 类 号：R576[医药卫生—消化系统]