评价急性生理学与慢性健康状况评分在急重症监护中的应用

Comparison of APACHEⅡ and APACHEⅢ in emergency

目的评价急性生理学与慢性健康状况评分Ⅱ、Ⅲ(APACHEⅡ、APACHEⅢ)在急诊重症监护室(EICU)的适用性和优劣性。方法收集2007年3月～12月入住四川大学华西医院EICU患者98例资料,其中存活组71例,死亡组28例,按APACHEⅡ和APACHEⅢ所需数据进行统计评分并相互比较,计算出APACHEⅡ的死亡概率(Ps),与实际死亡率进行对比。结果死亡组APACHEⅡ和APACHEⅢ分值均高于存活组(P均<0.01),二者分值均与病死率呈正相关,但在急性生理学评分(APS)的比较中仅有APACHEⅢ有显著差异(P<0.01)。在死亡概率预测中,Ps≤0.5者病死率明显高于Ps>0.5者,预测死亡危险率与实际病死率呈直线正相关。结论APACHEHEⅡ和A-PACHEⅢ皆可用于EICU的病情评估,APACHEDEⅢ的设计更为合理和严密,APACHEⅡ较简单易用。

Objective Acute physiology and chronic health evaluation Ⅱ and Ⅲ （APACHE Ⅱ and APACHE Ⅲ ） were applied respectively to evaluate the severity and prognosis of the patients in the emergency intensive care unit （EICU）. Methods 98 patients were enrolled. According to APACHEⅡ and APACHEⅢ, probability of death（Ps） that was calculated was compared with the actual mortality. Results The scores of APACHEⅡ and APACHEⅢ in recovery group were higher than in death group {P〈0. 01）, the both scores were propotional with the mortality. Whereas comparison in acute physiology score （APS） of APACHEⅢ was significant difference {P〈0.01）. In the prediction in probability of death, the actual mortality of Ps≤0. 5 group was higher than the Ps〉0.5 group, and probability of death was positive correlation with the actual mortality. Conclusion Both of APACHEⅡ and APACHEⅢ were applied to evaluate the severity of the patients in EICU. Design of APACHEⅢ was more reasonable and accurate, but APACHE Ⅱ was more simple and convenient.