APACHEⅡ、SOFA及aCCI评分对重症老年髋部骨折术后患者预后的评估价值  

Evaluation of APACHEⅡ,SOFA,and aCCI scores in prognosis of elderly patients with critical hip fractures after surgery

作　　者：佟梦琦 王姗 王郝 白颖 TONG Mengqi;WANG Shan;WANG Hao;BAI Ying(Department of Intensive Care Unit,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;Department of Mathematics and Statistics,University of San Francisco,San Francisco 94117,USA)

机构地区：[1]首都医科大学附属北京积水潭医院重症医学科,北京100035 [2]旧金山大学数学与统计学系,美国旧金山94117

出　　处：《贵州医科大学学报》2024年第10期1542-1548,共7页Journal of Guizhou Medical University

基　　金：北京市属医院科研培育计划(PX2022014)。

摘　　要：目的探讨急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)及年龄校正查尔森合并症指数(aCCI)评分对重症老年髋部骨折术后患者预后的评估价值。方法选取重症老年髋部骨折术后患者119例为研究对象,收集患者入院后的临床信息(年龄、性别、基础疾病状况、骨折部位、手术方式及麻醉方式等)和术后入重症医学科(ICU)即刻及第1天(24 h)的临床资料[体温、平均动脉压、心率、呼吸频率、尿量及格拉斯哥昏迷评分(GCS)等];采集患者入ICU即刻及术后第1天清晨的静脉血和动脉血,采用全自动血液细胞分析仪和全自动生化分析仪检测红细胞压积、白细胞计数、血小板计数及血清钠、钾、肌酐、胆红素,采用血气分析仪检测动脉血pH值、氧分压(PaO_(2))及二氧化碳分压(PaCO_(2)),记录吸入氧浓度(FiO_(2))并计算改良氧合指数(P/F=PaO_(2)/FiO_(2))或肺泡动脉血氧分压差(A-aDO_(2));采用APACHEⅡ、SOFA及aCCI评分评估患者术后入ICU即刻及第1天(24 h)的病情严重程度;患者出院后随访12个月,记录患者术后并发症及术后第30天和第12个月的结局(存活或死亡);采用线性分析及logistic回归分析3种评分与患者预后的相关性,采用受试者工作特征(ROC)曲线评估3种评分对患者死亡风险的预测价值。结果单变量线性分析显示,患者ICU住院时间、总住院时间与APACHEⅡ、SOFA及aCCI评分均具有相关性,评分越高、ICU住院时间和总住院时间越长(P<0.01);logistic回归分析显示,并发症组重症老年髋部骨折术后患者APACHEⅡ、aCCI评分均明显高于无并发症组患者(P<0.01);随访结果显示,术后30 d内死亡组患者aCCI评分高于存活组(P<0.01),术后12个月内死亡组患者APACHEⅡ及aCCI评分高于存活组(P<0.05);3种评分中aCCI评分的ROC实际曲线下面积(AUC)于术后第30天(0.90)及第12个月(0.73)最大。结论APACHEⅡ、SOFA及aCCI评分均可有效Objective To evaluate the effect of acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)and age-adjusted charlson comorbidity index(aCCI)on the prognosis of elderly patients after critical hip fracture surgery.Methods In the study 119 elderly patients with critical hip fractures after surgery were selected as the research subjects.Clinical information were retrospectively collected,including age,gender,comorbidities,types of fracture,types of surgery,types of anesthesia,etc.Clinical data were recorded on the day of ICU admission and the first day after surgery,including temperature,mean arterial pressure,heart rate,respiratory rate,urine output,Glasgow coma score(GCS),etc.Patients'venous and arterial blood samples were collected immediately upon ICU admission and in the early morning of the first day after surgery.Hematocrit,white blood cell count,platelet count,serum sodium,potassium,creatinine,and bilirubin were measured using the automated hematology analyzer and automated biochemistry analyzer.Arterial blood pH,arterial partial pressure of oxygen(PaO_(2)),and arterial partial pressure of carbon dioxide(PaCO_(2))were measured using the blood gas analyzer.The fraction of inspired oxygen(FiO_(2))was recorded,and the modified oxygenation index(P/F=PaO_(2)/FiO_(2))or alveolar-arterial oxygen difference(A-aDO_(2))was calculated.The APACHEⅡscore,SOFA score,and aCCI were used to assess the patients'conditions on the day of ICU admission and the first day after surgery.The patients were followed up for 12 months after discharge,when postoperative complications,length of ICU stay,total length of hospital stay and outcomes(survival or mortality)on the 30 th day and in the 12 th month after surgery were recorded.Linear regression and logistic regression were used to analyze the correlation between the 3 kinds of scoring and the prognosis of the patients.The predictive value of the 3 scoring systems for patient mortality risk was assessed using receiver operating charact

关 键 词：老年人 预后 髋部骨折 急性生理学与慢性健康状况评分Ⅱ 序贯器官衰竭评分 年龄校正的查尔森合并症指数 

分 类 号：R641[医药卫生—外科学]