APACHEⅡ评分、SAPSⅡ评分和SOFA评分对心脏停搏复苏成功患者预后评估的临床研究  

Clinical Study of APACHEⅡ,SAPSⅡ and SOFA Scores for Prognosis Assessment of Patients with Successful Cardiac Arrest and Resuscitation

作　　者：赵海洋 王苗苗[1] 马帅[1] 梅雪[1] 郭树彬[1] ZHAO Haiyang;WANG Miaomiao;MA Shuai;MEI Xue;GUO Shubin(Emergency Medicine Clinical Research Center/Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院急诊医学临床研究中心,心肺脑复苏北京市重点实验室,北京100020

出　　处：《医学综述》2021年第17期3531-3536,共6页Medical Recapitulate

摘　　要：目的探讨急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)、简化急性生理学评分Ⅱ(SAPSⅡ)评分和序贯性器官功能衰竭评估(SOFA)评分对心脏停搏复苏后自主循环恢复患者预后的评估价值。方法回顾分析2019年1月至2020年12月首都医科大学附属北京朝阳医院收治的61例心脏停搏复苏后自主循环恢复患者的病历资料,根据复苏后28 d的生存情况分为生存组(33例)和死亡组(28例);根据格拉斯哥-匹兹堡脑功能表现分级评分分为脑功能预后良好组(19例)和脑功能预后不良组(42例)。收集复苏后24 h的APACHEⅡ、SAPSⅡ评分及SOFA评分,采用受试者工作特征曲线(ROC)曲线下面积(AUC)和Logistic回归分析评价结果的可预测性。结果死亡组APACHEⅡ、SAPSⅡ评分及SOFA评分显著高于生存组[(35.3±1.7)分比(21.6±1.5)分、(70.0±2.0)分比(40.2±2.6)分、(10.3±0.5)分比(7.0±0.6)分](P<0.01),脑功能预后不良组APACHEⅡ、SAPSⅡ评分及SOFA评分亦显著高于脑功能预后良好组[(26.9±2.1)分比(17.7±1.6)分、(51.9±3.1)分比(31.6±2.5)分、(8.4±0.6)分比(5.9±0.9)分](P<0.05或P<0.01)。ROC曲线分析显示,APACHEⅡ、SAPSⅡ评分及SOFA评分预测患者28 d死亡的AUC分别为0.859、0.949、0.763,预测脑功能预后的AUC分别为0.898、0.927、0.758,APACHEⅡ评分、SAPSⅡ评分对死亡和脑功能预后的预测价值高于SOFA评分(P<0.05)。Logistic回归分析显示,APACHEⅡ、SAPSⅡ评分及SOFA评分均是心脏停搏复苏后自主循环恢复患者死亡和脑功能预后的独立危险因素(P<0.05)。结论 APACHEⅡ、SAPSⅡ评分及SOFA评分均是心脏停搏复苏后自主循环恢复患者死亡率和脑功能预后的独立危险因素,APACHEⅡ评分和SAPSⅡ评分的预测效果优于SOFA评分。Objective To investigate the prognostic value of acute physiology and chronic health score system Ⅱ(APACHEⅡ),simplified acute physiology score Ⅱ(SAPSⅡ) and sequential organ failure assessment(SOFA) in patients with spontaneous circulation recovery after cardiac arrest and resuscitation.Methods The clinical data of 61 patients with spontaneous circulation recovery after cardiac arrest and resuscitation in Beijing Chao-Yang Hospital, Capital Medical University from Jan.2019 to Dec.2020 were retrospectively analyzed.According to the 28 d survival after resuscitation, they were divided into a survival group(33 cases) and a death group(28 cases);according to Glasgow Pittsburgh brain function grading score, they were divided into a good prognosis group(19 cases) and a poor prognosis group(42 cases).APACHEⅡ,SAPSⅡ and SOFA scores were collected 24 hours after resuscitation.Area under curve(AUC) of receiver operatingcharacteristic(ROC) and Logistic regression analysis were used to evaluate the predictability of the outcomes.Results The scores of APACHEⅡ,SAPS Ⅱ and SOFA in the death group were significantly higher than those in the survival group [(35.3±1.7) vs(21.6±1.5),(70.0±2.0) vs(40.2±2.6),(10.3±0.5) vs(7.0±0.6)](P<0.01).The scores of APACHEⅡ,SAPSⅡ and SOFA in the poor prognosis group were also significantly higher than those in the good prognosis group[(26.9±2.1) vs(17.7±1.6),(51.9±3.1) vs(31.6±2.5),(8.4±0.6) vs(5.9±0.9)](P<0.05 or P<0.01).ROC curve analysis showed that the AUC of APACHEⅡ,SAPS Ⅱ and SOFA scores in predicting 28 d death were 0.859,0.949 and 0.763 respectively, and the AUC of predicting brain function prognosis were 0.898,0.927 and 0.758 respectively.The predictive value of APACHEⅡ and SAPSⅡ scores in predicting death and brain function prognosis was higher than that of SOFA score(P<0.05).Logistic regression analysis showed that APACHEⅡ,SAPS Ⅱ and SOFA scores were independent risk factors for mortality and prognosis of brain function in patients with spontane

关 键 词：心脏停搏 心肺复苏 序贯器官衰竭评分 急性生理学和慢性健康状况评分系统Ⅱ 简化急性生理学评分Ⅱ 

分 类 号：R541.78[医药卫生—心血管疾病]