社区获得性肺炎CURB-65与APACHEⅡ评分对比研究

CURB-65 criteria and APACHEⅡ score in community-acquired pneumonia:an comparative study

目的研究社区获得性肺炎(CAP)患者CURB-65评分(英国胸科协会改良肺炎评分)与APACHEⅡ评分(急性生理学及慢性健康状况评分)的相关性及在预后中的预测价值。方法选取952例社区获得性肺炎患者,进行CURB-65评分与APACHEⅡ评分,分析2种评分的相关性。结果 CURB-65评分不同分层其机械通气率、多器官功能障碍综合征(MODS)发生率、死亡率分别是低危组:8.6%、3.4%、1.3%;中危组:28.7%、13.2%、6.4%;高危组:79.1%、47.3%、20.2%;APACHEⅡ评分不同分层其机械通气率、MODS发生率、死亡率分别是低危组:7.6%、2.3%、1.1%;中危组:31.2%、10.5%、4.9%;高危组:69.3%、52.1%、21.4%;同一分层,不同评分系统,其机械通气率、MODS发生率、死亡率差异无统计学意义,不同的分层,随着分值增加,其机械通气率、MODS发生率、死亡率均显著增加(P<0.05);CAP患者CURB-65评分和APACHEⅡ评分之间存在明显的相关性(r=0.848),机械通气、MODS、死亡患者CURB-65评分和APACHEⅡ评分明显高于非机械通气、MODS及非死亡患者(P<0.05)。结论 CURB-65评分与APACHEⅡ评分一样,对CAP患者的机械通气率、MODS发生率及预后有同样的预测作用,是CAP患者病情严重度和病死率预测的独立的重要因素之一。

OBJECTIVE To discuss the relativity between CURB-65 criteria and APACHEⅡscores in Community acquired pneumonia（CAP）and the value in predicting prognosis.METHODS A total of 952 cases of community acquired pneumonia（CAP）were evaluated according to CURB-65 criteria and APACHEⅡ scores when they visited to our hospital.The relativity between CURB-65 criteria and APACHEⅡ score was analyzed.RESULTS The incidence of mechanical ventilation,MODS and mortality rates in different levels of CURB-65 criteria were 8.6%,3.4% and 1.3%,respectively,in low risk group.Of those was 28.7%,13.2% and 6.4%,respectively,in medial group.Of those was 79.1%,47.3% and 20.2%,respectively,in high risk group.The incidence of mechanical ventilation,MODS and mortality rates in different levels of APACHEⅡscores was 7.6%,2.3% and 1.1%,respectively,in low risk group.Of those were 31.2%,10.5% and 4.9%,respectively,in medial group.Of those were 69.3%,52.1% and 21.4%,respectively,in high risk group.The incidence of mechanical ventilation,MODS and mortality rates had no significant difference in same level between CURB-65 criteria and APACHEⅡscores（P0.05）.The incidence of mechanical ventilation,MODS and mortality rates were increased with scores in different levels（P0.05）.there was a significant positive correlation between CURB-65 criteria and APACHEⅡ scores（r=0.848）.CURB-65 criteria and APACHEⅡ scores in the mechanical ventilation group,MODS group and died group were higher than those no mechanical ventilation group,no MODS group and survival group（P0.05）.CONCLUSION CURB-65 criteria has the same function as APACHEⅡ scores in evaluating the incidence of mechanical ventilation,MODS and mortality rates in community-acquired pneumonia（CAP）.Both CURB-65 criteria and APACHEⅡ scores are independent and important predictors of severity and mortality in CAP patients.