三种评分标准对慢性阻塞性肺疾病急性加重期并Ⅱ型呼吸衰竭患者预后评估价值的探讨

The approach of three kinds of score evaluating the prognosis of acute exacerbation of chronic ob- structive pulmonary diseases with type Ⅱ respiratory failure

目的探讨急性生理学与慢性健康状况评分（APACHEⅡ）、临床肺部感染评分（CPIS）和慢性阻塞性肺疾病和支气管哮喘生理评分（CAPS）对慢性阻塞性肺疾病急性加重期（AECOPD）并Ⅱ型呼吸衰竭患者预后评估的应用价值。方法回顾性分析138例AECOPD并Ⅱ型呼吸衰竭患者的临床资料，在入院24小时内分别进行APACHEⅡ、CPIS及CAPS评分，比较不同预后患者3种评分分值的差别；计算每种评分标准不同分值患者的死亡率；根据Logstic回归模型与ROC曲线评估3种评分标准对AECOPD并Ⅱ型呼吸衰竭患者预后判断的校准度与分辨度。结果不同预后患者在APACHEⅡ、CPIS和CAPS评分分值之间比较差异有统计学意义（P〈0．05）。当APACHEⅡ分值≥24分，CPIS分值≥7分，CAPS分值≥35分时患者病死率较高（P〈0．05）。Logstic回归模型显示，3种评分标准对AECOPD并Ⅱ型呼吸衰竭患者生存预后结局的预测均有较好的校准度。结论死亡组患者APACHEⅡ、CHS和CAPS评分均值均高于生存组患者；APACHEⅡ分值≥24分、CPIS分值37分、CAPS分值≥35分时患者病死率较高；APACHEⅡ评分对确定AECOPD并Ⅱ型呼吸衰竭患者生存预测的校准度和分辨度最高。

Objective To explore the value of the acute physiology and chronic health evaluation （APACHE Ⅱ ） , the clinical pulmonary infection score（CPIS） and chronic obstructive pulmonary disease and asthma physiology score （CAPS） evaluating the prognosis with acute exacerbation of chronic obstruc- tive pulmonary disease （AECOPD） combination of respiratory failure Ⅱ. Method To analyze the APACHE Ⅱ , CPIS and CAPS retrospectively of all 138 patients with AECOPD combination of respiratory failure Ⅱ who were taken during 24 hours. The 138 patients were divided into death group and survival group, compare the difference of the APACHE Ⅱ , CPIS and CAPS of the two groups, analyze the relation- ship between each score and the respective death rate and evaluate the adjustment and discernment of the three scores judging the prognosis of AECOPD combination of respiratory failureⅡ. Result There were apparent differences during the three scores of APACHE Ⅱ , CPIS and CAPS of each group, （ P 〈 0.05 ） ; APACHE 11 ≥ 24 scores, CPIS ≥ 7 scores, CAPS≥35 scores indicates higher death rate （ P 〈 0.05 ） ; the score of APACHE Ⅱ , CPIS and CAPS could predict the prognosis of AECOPD combination of respiratory failure Ⅱ. Conclusion The APACHE Ⅱ ,CPIS and CAPS scores during the death group are higher than those during the survival group ; APACHE Ⅱ ≥ 24 scores, CPIS≥ 7 scores, CAPS≥35 scores indicate higher death rate; the score of APACHE II can predict the prognosis of AECOPD combination of respirato- ry failure Ⅱ better than CPIS and CAPS.