三种评分系统对心脏瓣膜置换术后患者预后评估的分析

Analysis of prognosis assessment with three assess methods for the postoperative patients with heart valve replacement surgery

目的:分析比较在心脏瓣膜置换术后应用急性生理学和慢性健康状况评分Ⅲ(APACHEⅢ)、MODS和SOFA 评分系统对患者预后评估的临床意义。方法:对2004年7～12月在我院行心脏瓣膜置换手术的86例患者,在心脏外科重症监护室(CSICU)期间每日应用APACHEⅢ、MODS和SOFA评分评估其预后,并做统计学分析。结果:三种评分在术后3 d内各自无统计学差异,术后3 d APACHEⅢ评分与MODS评分始终保持正相关关系,但其相关性呈下降趋势(r=0．532,r=0．557,r=0．321;P=0．000,P=0．020,P=0．034);术后3 d APACHEⅢ评分与SOFA 评分相关性显著(r分别为0．420,0．523,0．461;P分别为=0．000,=0．026,=0．018);ICU停留时间与术后3 d 三种评分呈相关性(r分别为0．484．0．510,0．440;P均=0．000);术后医院停留时间与A1、A2、A3有相关性 (r分别为0．431,0．874．0．314;P=0．000,=0．000,=0．005)。结论:对心脏瓣膜置换术后患者,三种评分对患者ICU停留时间均有很好的提示作用,而APACHEⅢ评分可较准确地预测患者术后医院停留时间。

Objective：To analysis the clinic significance of the prognosis assess with acute disease physiology and chron ic health evaluation Ⅲ （APACHE Ⅲ ）, multiple organ dysfunction score （MODS） and sequential organ failure assessment （SOFA） for postoperative patients with heart valve replacement surgery. Methods ： The prognosis of 86 patients undertook heart valve replacement operation was assessed with APACHE Ⅲ , MODS and SOFA scoring system. Then calculate and compare the scores of 3 methods everyday while they stayed in cardiac surgery intensive care unit （CSICU）. Results ：There were no difference in first three days postoperatively in each APACHE Ⅲ ,MODS and SOFA Score ,but there was significant correlation among APACHE Ⅲ and MODS （r= 0. 532,r= 0. 557,r= 0.321;P= 0. 000. P=0.020, P=0.034）, SOFA （r=0.420, 0.523, 0.461; P=0.000, =0.026, =0.018）; The detention times in CSICU and the score of three methods had significant correlation （r=0. 484, 0. 510, 0. 440; P=0. 000 all）; The total times in hospital after operation had significant correlation with A1, A2, A3 （r=0. 431, 0. 874, 0. 314; P=0. 000, =0. 000, = 0. 005 respectively）, and no correlation with M1, M2, M3 and S1, S2,S3. Conclusion ： For the postoperative patients with heart valve replacement surgery, APACHE Ⅲ , MODS, SOFA can well assess the detention times in CSICU, and APACHE Ⅲ can precisely assess the total times in hospital after operation.