APACHEII评分在ICU产科危重患者监护中的应用

The role of acute physiology and chronic health evaluation II in intensive care for critically ill obstetric patients

目的 评估急性生理学与慢性健康状况评分II(APACHEII)在预测ICU产科危重患者的病情预后及监护指导中的应用效果。方法 连续观察 2 0 0 0年 1月～ 2 0 0 4年 4月转入ICU资料完整产科危重患者 82例 ,应用APACHEII评分预测患者预后及制订ICU监护级别。结果 82例产科危重患者APACHEII评分范围 6～ 5 6分 ,平均 (2 0 .0 2± 9.5 5 )分 ;6 5例生存者评分为 (18.2 4±6 .95 )分 ;17例死亡者评分为 (30 .39± 10 .5 4 )分 ,两者差异有显著性 (P <0 .0 1) ;随着APACHEII评分的增高 ,患者实际病死率及预测病死率均升高 ;APACHEII评分 >2 1分组ICU监护级别A ,患者死亡率为 4 5 .4 5 %。结论 APACHEII评分系统能在一定程度上评价产科危重患者疾病的严重程度和预测预后 ;能对产科ICU监护级别进行指导 ;结果也提示APACHEII评分 <10分的产科患者不需要进入ICU监护。

Objective To determine the outcome predictability and the intensive care grade given in critically ill obstetric patients admitted to GICU using the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system. Methods Consecutive critically ill obstetric patients (n=82) admitted to general intensive care unit from Jan 2000 to Apr 2004 were studied to determine whether mortality prediction is feasible in critically ill obstetric patients based on APACHE II. Furthermore, the intensive care grade was given for the patients depended on APACHE II. Results APACHE II scores of these critically ill obstetric patients were in the range of 6 to 56, average (20.02±9.55), with average score of (18.24±6.95) for 65 survivors and (30.39±10.54 ) for 17 death cases. There was a significant difference between the two groups of patients (P<0.01). Actual and predicted mortality increased along with the increase in APACHE II scores. The mortality in the patients with intensive care grade A, in which APACHE II >21, was only 45.45%. Conclusion APACHE II can be used to predict the prognosis of critically ill obstetric patients admitted to GICU and to determine the intensive care grade given for the patients. Our results also suggested that the patients with APACHE II<10 should not be admitted to ICU.