脑出血评分联合APACHE Ⅱ评分评估自发性脑出血患者预后的价值  

Predictive Value of Intracerebral Hemorrhage Score Combined with APACHE Ⅱ Score in the Prognosis of Spontaneous Cerebral Hemorrhage

作　　者：蒋文韬[1] 黄建华[1] 朱家双 JIANG Wen-tao;HUANG Jian-hua;ZHU Jia-shuang(Department of Emergency Critical Care Medicine, First Peoples Hospital of Bengbu ,Anhui Province , 233000)

机构地区：[1]安徽省蚌埠市第一人民医院急诊重症医学科,安徽蚌埠233000

出　　处：《医学临床研究》2019年第9期1724-1726,共3页Journal of Clinical Research

摘　　要：[目的]探讨脑出血评分联合急性生理与慢性健康评分Ⅱ(APACHE Ⅱ)评估自发性脑出血(SICH )患者预后的价值.[方法]选择2015年11月至2018年12月收治的42例SICH患者为对象,于入院时测评脑出血评分,于入院24 h内测评APACHE Ⅱ评分,于发病1个月时测评改良Rankin量表(M RS )评分,以MRS ≥ 4分为预后不良,评估脑出血评分、APACHE Ⅱ评分单用及联用对患者预后的预测价值.[结果]参考M RS评分,预后不良19例(45 .24%),预后良好23例(54 .76%).预后不良组脑出血评分及A‐PACHE Ⅱ评分均明显高于预后良好组,差异有统计学意义( P <0 .05).脑出血评分、APACHE Ⅱ评分预测不良预后的ROC曲线下面积分别为0 .841 (95% CI=0 .724~0 .958 , P < 0 .001 )、0 .817 (95% CI= 0 .690~0 .944 ,P <0 .001).联用方案具有最高的特异度、阳性预测值及预测准确率;单用方案的敏感度及阴性预测值较高,但预测准确率最差.[结论]脑出血评分≥2分、APACHE Ⅱ评分≥19分对预测SICH患者不良预后有较好的价值,单用方案能够提升预测特异度、阳性预测值及预测准确率.[Objective]To explore the predictive value of intracerebral hemorrhage score combined with a‐cute physiology and chronic health score Ⅱ(APACHE Ⅱ) in predicting the prognosis of patients with sponta‐neous intracerebral hemorrhage (SICH ).[M ethods] Forty‐two patients with SICH admitted from November 2015 to December 2018 were selected as subjects .T he cerebral hemorrhage score was evaluated at admission , APACHE Ⅱ score was evaluated within 24 hours of admission ,and the modified Rankin scale (M RS ) score was evaluated at 1 month of onset ,poor prognosis was defined as M RS ≥ 4 .T he prognostic value of cerebral hemorrhage score and APACHE Ⅱ score alone and in combination was evaluated .[Results] According to M RS score ,19 cases (45 .24%) had poor prognosis and 23 cases (54 .76%) had good prognosis .T he scores of cerebral hemorrhage and APACHE Ⅱ in poor prognosis group were significantly higher than those in the good prognosis group ( P <0 .05).T he area under ROC curve of cerebral hemorrhage score and APACHE Ⅱ score predicting poor prognosis was 0 .841 (95% CI = 0 .724~0 .958 ,P <0 .001) ,0 .817 (95% CI = 0 .690~0 .944 , P <0 .001) ,respectively .T he combined scheme had the highest specificity ,positive predictive value and pre‐dictive accuracy ,while the single scheme had higher sensitivity and negative predictive value ,but the predic‐tion accuracy was the worst .[Conclusion]Both intracerebral hemorrhage score ≥ 2 and APACHE Ⅱ score ≥19 points have good value in predicting the adverse prognosis of SICH patients .Serial connection can improve the predictive specificity ,positive predictive value and predictive accuracy .

关 键 词：脑出血/诊断 器官功能障碍评分 

分 类 号：R743.34[医药卫生—神经病学与精神病学]