APACHEⅢ评分在评估急性百草枯中毒患者预后中的临床价值  

Clinical value of APACHEⅢscore in evaluating the prognosis of pa-tients with acute paraquat poisoning

作　　者：杨梦莹 刘振宁[1] YANG Mengying;LIU Zhenning(Department of Emer‐gency Medicine,Shengjing Hospital of China Medical University,Shenyang Liaoning 110004,China)

机构地区：[1]中国医科大学附属盛京医院急诊科,辽宁沈阳110004 [2]复旦大学附属华山医院北院急重症医学科,上海201907

出　　处：《中国急救复苏与灾害医学杂志》2021年第9期988-991,1007,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：辽宁省科技厅重点研发计划项目(编号:2018225095)。

摘　　要：目的探讨急性生理学与慢性健康状况评分系统Ⅲ(acute physiology and chronic health evaluationⅢ,APACHEⅢ)评分对急性百草枯中毒患者预后的早期评估价值。方法选取2013年1月-2019年3月在中国医科大学附属盛京医院治疗的163例急性百草枯中毒患者的病例资料进行回顾性分析。根据患者的预后情况,将患者分为存活组和死亡组。计算患者入院、24 h及48 h的全身炎症反应综合征(SIRS)评分、急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation,APACHEⅡ评分)、APACHEⅢ评分、急性生理功能Ⅱ(simplified acute physiological scoreⅡ,SAPSⅡ)评分、中毒严重程度(poisoning severity score,PSS)评分。分析比较两组患者的各评分系统分值,同时绘制受试者工作特征曲线(receiver operating characteristic,ROC),通过ROC曲线下面积(area under the curve,AUC)评价各评分系统对于急性百草枯中毒预后的预测价值。结果除入院时SAPSⅡ评分外,比较两组患者之间其余不同时间点的评分均有显著性差异(P<0.05)。ROC曲线分析结果表明,在入院24 h时,只有APACHEⅢ评分的AUC为0.808,其余4个评分系统的AUC均在0.8以下。在48 h时,虽然APACHEⅢ和APACHEⅡ评分AUC均超过0.9,但APACHEⅢ评分最大,达到0.931;当APACHEⅢ评分截断值为14.5时,APACHEⅢ评分灵敏度达到92.1%,诊断准确率达到87.1%,优于其他评分系统。结论入院48 h内APACHEⅢ评分大于14.5时,急性百草枯中毒患者预后不佳。APACHEⅢ评分可以评估急性百草枯中毒患者的预后。Objective To explore the early evaluation value of acute Physiology and Chronic HealthⅢ(APACHEⅢ)score on the prognosis of patients with acute paraquat poisoning.Methods The data of 163 patients with acute para‐quat poisoning treated in Shengjing Hospital of China Medical University from January 2013 to March 2019 were ret‐rospectively analyzed.According to the outcome of the patients,the patients were distributed into the survival and death groups.The systemic inflammatory response syndrome(SIRS)score,acute physiology and chronic health statusⅡ(APACHEⅡ)score,acute physiology and chronic health statusⅢ(APACHEⅢ)score,acute physiological func‐tionⅡ(SAPSⅡ)score,severe poisoning score(PSS)at the time of admission,24 h and 48 h of admission were calcu‐lated.The scores of each scoring system in the survival and death groups were compared,and then,the predictive val‐ue of each scoring system was evaluated for the prognosis of acute paraquat poisoning according to the receiver oper‐ating characteristic curve(ROC)and the area under the ROC curve(AUC).Results Except the SAPSⅡscore at ad‐mission,the other scoring systems at the different timepoints were significantly different between the two groups.Ac‐cording to the results of ROC analysis,only the AUC of APACHEⅢscore at 24 h of admission was 0.808,the other scoring system were less than 0.8.Although the AUCs of APACHEⅢscore and APACHEⅡscore at 48 h of admis‐sion exceeded 0.9,only the AUC of APACHEⅢscore was 0.931,with a highest level.When the APACHEⅢscore was 14.5,the sensitivity and diagnostic accuracy were 92.1%and 87.1%,respectively,better than the other scoring system.Conclusion APACHEⅢscore at 48 h of admission more than 14.5 indicated a poor outcome in patients with acute paraquat poisoning.APACHEⅢscore could assess the prognosis of patients with acute paraquat poisoning.

关 键 词：百草枯中毒 APACHEⅢ APACHEⅡ SAPSⅡ 预后 

分 类 号：R595[医药卫生—内科学]