急性生理和慢性健康状况评分系统在评价心血管疾病危重情况及预测预后的应用

Application of Acute Physiology and Chronic Health Evaluation-Ⅱ Scoring System in Patients With Critical Cardiovascular Disease

目的：探讨急性生理和慢性健康状况评分系统-Ⅱ（APACHE-Ⅱ）判断心血管疾病危重情况及预测预后的能力。方法：连续入选1439例心血管重症患者，计算每个人的APACHE-Ⅱ分值和死亡危险性，按分值（〈10分组，10～20分组，〉20分组）和疾病类型（先天性心脏病，冠心病，心脏瓣膜病，肺源性心脏病，心肌疾病）分类比较每组实际和预测病死率，以及实际死亡情况和分值之间的关系。结果：R0C曲线下的面积为0．689，诊断价值较低。实际病死亡率随APACHE-Ⅱ分值而增加。除〉20分组和肺源性心脏病预测病死率在实际病死率95％可信区间内，其余预测能力差。结论：APACHE-Ⅱ对于心血管疾病病死率的预测并不理想，应寻找更适合于心血管疾病的评分方式。

Objective ： To assess the acute physiology and chronic health evaluation- lI （ APACHE- lI ） scoring system for predicting the severity of cardiovascular disease and the mortality of the critical patients treated at ICU. Methods ：A total of 1439 consecutive patients treated at ICU of our hospital from 2003 to 2007 were summarized. The patients were divided into three groups, APACHE-II score 〈 10 group, n = 423, APACHE-11 score 10 -20 group,n = 961, and APACHE- II score 〉 20 group, n = 55. The scoring predicted mortality and real mortality,the correlation between APACHE-Ⅱ score and real mortality were calculated and compared in different groups. Results ： The area of APACHE- Ⅱ predicted mortality under ROC curve was 0. 689, which implied the low predictive value of real mortality for the APACHE- Ⅱ scoring system. The real mortality increased along with the elevation of APACHE- Ⅱ score. In APACHE-lI score 〉 20 group and in patients with pulmonary heart disease, the scoring predicted mortality was in 95% CI of the real mortality. While in the other two groups, the scoring predicted mortality was quite different from the real mortality. Conclusion ： The predictive value of APACHE- Ⅱ scoring system was not accurate for evaluating the real mortality in patients with critical cardiovascular disease.