慢性阻塞性肺疾病和支气管哮喘生理评分对慢性阻塞性肺疾病急性加重期伴呼吸衰竭患者病情评估的价值研究

The study on the value of using the chronic obstructive pulmonary disease and asthma physiology score to assess the severity of acute exacerbation in patients with chronic obstructive pulmonary disease complicated by type Ⅱ respiratory failure

目的探讨慢性阻塞性肺疾病和支气管哮喘生理评分（CAPs）在慢性阻塞性肺疾病急性加重期（AEc0PD）伴呼吸衰竭患者病情评估中的应用价值。方法采用回顾性分析方法，选择2005年1月至2009年3月收治的82例AECOPD伴呼吸衰竭患者临床资料，分别用CAPS、急性生理学与慢性健康状况评分系统（APACHEⅡ和APACHEⅢ）对存活和死亡患者进行评分，然后进行统计学处理与分析。结果死亡组19例患者CAPS、APACHEⅡ、APACHEⅢ评分、有创通气时间、住ICU时间分别为（34．21±9．89）分、（22．53±7．49）分、（75．11±18．07）分、（25．06±24．64）d、（32．42±25．49）d；存活组63例患者分别为（27．41±8．15）分、（18．65±5．34）分、（64．11±15．92）分、（5．23±5．50）d、（12．51±20．70）d，两组间比较差异均有统计学意义（P〈0．05或P〈0．01）。CAPS、APACHEⅡ和APACHEⅢ评分的受试者工作特征曲线（ROC曲线）下面积分别是0．712（P=0．005）、0．654（P=0．043）和0．655（P=0．042）；CAPS评分为30．5分时约登指数最大，为0．435。CAPS评分与病死率呈正相关，且超过30分时病死率明显增加。结论CAPS对AECOPD伴呼吸衰竭患者的病情评估与预后判断具有良好的效果，简单、依从性好，且优于APACHEⅡ和APACHEⅢ评分。

Objective To explore the value of the chronic obstructive pulmonary disease （COPD） and asthma physiology score （CAPS） in evaluating the severity and prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated by type Ⅰ respiratory failure. Methods Eighty-two cases with AECOPD complicated by type Ⅰ respiratory failure between January 2005 and March 2009 were retrospectively analyzed. The severity in survivors and non-survivors was evaluated by CAPS and acute physiology and chronic health evaluation system （APACHE Ⅰ score, APACHE Ⅱ score）, and retrospective and statistical analyses of all data were performed. Results CAPS, APACHE Ⅰ score, APACHE Ⅲ score, duration of invasive positive pressure ventilation （IPPV） and days in intensive care unit of 19 cases in the death group were 34.21±9.89, 22.53 ± 7.49, 75.11 ± 18.07, （25.06±24.64） days, （32.42±25.49） days, respectively, while 63 cases of the survival group were 27.41±8.15, 18.65±5.34, 64.11±15.92, （5.23 ±5.50） days, （12.51 ± 20.70） days, respectively, and there were significant differences between two groups （P〈0. 05 or P〈0.01）. The areas under receiver operating characteristic （ROC） curves of CAPS, APACHE I score and APACHE Ⅰ score were 0. 712 （P=0. 005）, 0. 654 （P=0. 043） and 0. 655 （P=0.042）, respectively. When CAPS score was 30.5, Youden index was the highest （0.435）. The mortality rate had a positive correlation with CAPS. When the CAPS score was over 30, there was a tendency of increase in mortality rate. Conclusion CAPS is very useful to evaluate the severity and prognosis of patients with AECOPD complicated by type Ⅰ respiratory failure. It is easy to perform, and better than APACHE Ⅱ and APACHE Ⅱ.