APACHEⅡ评分对AECOPD患者病情评估的临床价值研究

Clinic value of APACHEⅡ on evaluating Acute Exacerbation of COPD (AECOPD) patients

目的评价急性生理学与慢性健康状况评分(APACHEII)对慢性阻塞性肺病(COPD)急性加重期患者病情评估的临床价值。方法对232例COPD急性加重期患者入院后2h内进行APACHEⅡ评分,随访30d后按预后分为存活组和死亡组,按临床处置方式分为药物治疗组、无创通气组和有创通气组。比较各组的APACHEII评分,行受试者工作特性曲线(ROC)分析。结果死亡组的APACHEII分值显著高于存活组。无创通气组ROC曲线下面积0.770,最佳截断值为18分。有创通气组ROC曲线下面积0.969,最佳截断值为28分。死亡组ROC曲线下面积0.946,最佳截断值为24分。结论APACHEII评分有助于评估COPD急性加重期患者的病情并指导其临床处置方式。

Objective To estimate the value of APACHE Ⅱ on evaluating acute exacerbation of COPD （AECOPD） patients and therapy options. Methods All of 232 patients were evaluated with APACHE Ⅱ within 2 hours after being received in the hospital. Their therapy options and prognosis were followed up for 30 days. The relationship of APACHE Ⅱ scores with different therapy options and prognosis were statistical analyzed after being divided into groups. Results The APACHE Ⅱ score of the death group was higher than that of the survival group. In the noninvasive ventilation group, the AUROCC of APACHE Ⅱ was 0. 770 and the best cutoff score was 18. In the invasive ventilation group, the AUROCC of APACHE Ⅱ was 0. 969 and the best cutoff score was 28. APACHE Ⅱ had the AUROCC 0. 946 and the best cutoff score 24 on mortality. Conclusion APACHE Ⅱ can be applied to evaluate the acute exacerbation of COPD （ AECOPD） patients. It helps to choose therapy options, and to decide the opportunity and the mechanic ventilation strategy.