APACHEⅡ评分对心肺复苏自主循环恢复昏迷患者预后预测的研究

Predictive study of the prognosis with APACHE Ⅱ score in coma patients with restoration of spontaneous circulation after cardiopulmonary resuscitation

目的探讨APACHEⅡ评分对心肺复苏自主循环恢复昏迷患者5种不同预后的区别能力。方法回顾性分析115例心肺复苏自主循环恢复住院患者的资料，比较不同预后患者的APACHEⅡ评分，计算其对两种严重不良（死亡或植物状态）预后与其他类型预后区别能力的ROC曲线下面积。结果5种不同预后（正常、神经功能轻度障碍、神经功能重度障碍、植物状态和死亡）患者APACHEⅡ评分比较差异有统计学意义（F=57．64，P=0．000）。各组之间相互比较，正常组与神经功能轻度障碍组、神经功能轻度障碍组与神经功能重度障碍组比较差异均无统计学意义[（8．89±5．52）分vs（12．50±6．00）分，P=0．109；（12．50±6．00）分vs（13．80±4．98）分，P=0．623]；其他各组之间相互比较差异均有统计学意义（正常组vs重度神经功能异常组P=0．019；其他各组之间比较均为P=0．000）。13分是区分预后良好的最佳截断点；23分是区分预后严重不良的最佳截断点。APACHEⅡ评分区分严重不良预后与其他类型预后能力的ROC曲线下面积为0．937。结论APACHEⅡ评分可以作为心肺复苏自主循环恢复昏迷患者不良预后的一个预测、评价工具，若引入其他相关因素，可望进一步提高该类患者不同预后的区别能力。

Objective To explore the discrimination ability of APACHE Ⅱ score in five different prognosis of coma patients with restoration of spontaneous circulation （ ROSC ） after cardiopulmonary resuscitation （ CPR）. Methods Data of 115 coma patients with ROSC after CPR were analyzed to compare the difference in APACHE Ⅱ score among five different prognosis { good cerebral performance, moderate cerebral disability, severe cerebral disability, vegetative state and death）. Its predictive power for two categories of patients with poor outcomes and other patients was evaluated by calculating areas under ROC Curve. Results There were differences in APACHE Ⅱ score of patients with five different prognosis （ F = 57. 64y 19 = 0. 000）. There, however, was no statistical difference between patients with good cerebral performance and moderate cerebral disability（8.89 ±5.52 vs 12.50 ±6.00, P =0. 109） , and between moderate cerebral disability group and severe cerebral disability group （ 12.50 ± 6.00 vs 13.80 ± 4.98, P =0.623 ）. There were significant differences among patients with other prognosis （ good cerebral performance group vs severe cerebral disability group： 8.89 ± 5.52 vs 13.80 ± 4.98, P = 0. 019 ; significant differences among patients with other prognosis P = 0. 000 ）. APACHE Ⅱ score was the most powerful to predict patients with good cerebral performance when it was under 13 and patients with poor outcomes （ death or vegetative state ） over 23. The area under ROC Curve for CPR ROSC Predictive Score to predict outcomes of the two kinds of patients was 0. 937. Conclusion APACHE Ⅱ score is more capable of exactly predicting the prognosis of patients with poor prognosis. The ability may be elevated if other correlative factors were introduced in it for predicting the final prognosis of coma survivors after cardiopulmonary resuscitation.