四种评分系统对呼吸重症监护室病人预后评估的比较

Comparision of four intensive care scoring models in the respiratory intensive care unit

目的 研究APACHEⅢ、SAPSⅡ、MPMⅡ 0和APACHEⅡ评分系统对呼吸重症监护室病人预后评估中的适用性和可行性 ,同时比较其优劣。方法 回顾性分析 2 16例呼吸重症监护室病人临床资料 ,进行APACHEⅢ、SAPSⅡ和APACHEⅡ评分 ,计算SAPSⅡ、APACHEⅡ和MPMⅡ 0的预计病死危险度。比较由SAPSⅡ、APACHEⅡ和MPMⅡ 0计算的病人院内病死概率和病人实际病死率之间的差异 ;同时用Hosmer-Lemeshow拟合优度检验和ROC曲线比较APACHEⅢ、SAPSⅡ和APACHEⅡ评分之间校准度和精确度的差异。结果 2 16例病人中死亡 77例 ,存活 139例 ,实际病死率 35 6 5 %。死亡组与存活组病人的APACHEⅡ、APACHEⅢ及SAPSⅡ评分在存活组与死亡组之间差异均有统计学意义 (P <0 0 5 )。APACHEⅡ、APACHEⅢ和SAPSⅡ的AUROCC分别为 0 74 4、0 74 1和 0 75 4 ,APACHEⅡ -PHM与实际病死率无显著性差异 (P >0 0 5 ) ,而SAPSⅡ -PHM和MPMⅡ 0与实际病死率有显著性差异 (P <0 0 5 )。结论 各种病情评价系统均可用于评价呼吸重症监护室病人的预后 ,4种病情评价系统中以APACHEⅡ最适于RICU病人。

Objectives To study four severity scoring systems, the Acute Physiology and Chronic Health Evaluation (APACHEⅡ,APACHEⅢ), the Simplified Acute Physiology Score (SAPS II) and the Mortality Probability Models(MPMⅡ0) in a respiratory intensive care unit(RICU) population Methods The patients who were admitted into the RICUs over 2 years were studied All 216 patients were scored and their predicted hospital mortality(PHM) were calculated with APACHEⅡ,APACHEⅢ,SAPSⅡ and MPMⅡ0 respectively Scores and PHMs were compared between survival group and nonsurvival group; The difference were compared between PHMs of APACHEⅡ, SAPSⅡ and MPMⅡ0 and actual mortality of all the patients ; The calibration and discrimination were compared among APACHEⅡ, APACHEⅢ and SAPSⅡ Results There were significant differences in APACHEⅡ,APACHEⅢ,SAPSⅡ and MPMⅡ0 between survival group and nonsurvival group; The hospital mortality of patients with risk of death was overpredicted by APACHEⅡ, but underpredicted by SAPSⅡ and MPMⅡ0 The area under the ROC curve was higher than 0 7 for APACHEⅡ, APACHEⅢ and SAPS II models, the calibration of APACHEⅡ was better than SAPSⅡ and MPMⅡ0 Conclusions All four evaluating systems can be used to evaluate the severity of the patients who are admitted into the respiratory intensive care units, and APACHEⅡ may be selected as the best one [