APACHEⅡ评分与AECOPD患者机械通气治疗预后的相关性分析  

Correlationship between APACHEⅡ scores and the prognosis of AECOPD patients with IMV

作　　者：刘魁[1] 彭文鸿[2] 王萍[2] 梁英 张学伟[2] 霍秀青[2] 李月越[2] 王小辉[2] 

机构地区：[1]安徽省亳州市人民医院呼吸内科,236800 [2]解放军第306医院呼吸内科,北京100101 [3]北京市小汤山医院内科,102211

出　　处：《中华临床医师杂志（电子版）》2015年第21期51-54,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的 总结分析慢性阻塞性肺疾病急性加重（AECOPD）伴重度Ⅱ型呼吸衰竭患者机械通气临床疗效及其预后与急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）的关系,以便针对性地指导临床治疗.方法 回顾性分析2008 年1 月至2012 年6 月我院呼吸与重症病房收治的64 例AECOPD合并重度Ⅱ型呼吸衰竭并行机械通气治疗患者的临床资料.采用Spearman 检验对APACHEⅡ评分与实际死亡率进行相关性分析,用受试者工作特征（ROC）曲线评价其对死亡的预测效能.结果 所有患者平均年龄（75.69±7.98）岁,最小54 岁,最大91 岁.机械通气时间3～226 d,中位通气时间13（7,25）d.最终35 例成功撤机拔管,撤机成功率54.7%;14 例撤机拔管失败;15例患者死亡,病死率23.4%.22 例患者通气时间大于21 d,占34.4%.随着APACHEⅡ评分的增加,病死率也逐渐增加,双变量相关分析显示,Spearman 相关系数rp=0.941（P=0.005）,APACHEⅡ评分预测的死亡率高于实际死亡率.APACHEⅡ评分ROC 曲线下面积Az=0.642（95%置信区间0.503～0.781,P=0.050）;评分为28.5 分时Youden 指数最大（0.398）,APACHEⅡ评分超过28 分,死亡率明显增加.结论 机械通气是抢救、治疗AECOPD 伴重度Ⅱ型呼吸衰竭患者的有效且可靠的手段,能够延长患者生存期.APACHEⅡ评分对AECOPD 伴重度Ⅱ型呼吸衰竭患者病情的评估有-定效果,但在预测患者死亡率方面的应用价值有限.ObjectiveTo determine the clinical correlation between acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in COPD patients with hypercapnic respiratory failure and invasive positive pressure ventilation (IPPV).Methods 64 cases of AECOPD with severe typeⅡ respiratory failure receiving the treatment of mechanical ventilation in RICU in the 306th hospital of PLA from January 2008 to June 2012 were retrospectively studied. The parameters of mechanical ventilation was analyzed by ttest; relationship between the predicted mortality of APACHEⅡ and actual mortality was analyzed by the Spearman correlation test, the application value of predicted mortality rate was evaluated by ROC curve.ResultsThe mean age of enrolled patients was (75.69±7.98) years, the minimum age was 54 years, the maximum age was 91 years. The total duration of mechanical ventilation ranged from 3 to 226 days, the median duration of MV was 13(7,25) days. Finally, 35 cases successfully ventilator-weaned, weaning success rate was 54.7%; 14 cases of weaning failed; 15 patients died, the mortality rate was 23.4%. 22 patients ventilated for more than 21 days, which accounted for 34.4%; 6 patients received repeated mechanical ventilation therapy. The mortality rate was higher with the increase of APACHEⅡ score, Spearman correlation analysis showed that the correlation coefficient rp=0.941(P=0.005), the predicted mortality of APACHEⅡ was higher than the actual mortality. The area under the ROC curve of APACHEⅡ(Az) was 0.642 (P=0.050, 95%CI: 0.503-0.781); when the APACHEⅡ score reached 28.5, the Youden index was the highest (0.398), so when the APACHEⅡ score was above 28 points, the mortality rate increased significantly.Conclusion Mechanical ventilation is an effective and reliable method to treat AECOPD accompanied with severe typeⅡ respiratory failure. APACHEⅡ score can be used to evaluate the severity of illness, but only has a limited value predicting the mortality for AECOPD patients with severe typeⅡ respirato

关 键 词：肺疾病 慢性阻塞性 呼吸功能不全 呼吸 人工 急性病生理学和长期健康评价 预后 

分 类 号：R563.9[医药卫生—呼吸系统]