急性生理和慢性健康状况评价系统Ⅱ在心血管急重症患者中的应用评价

Clinical application of acute physiology and chronic health evaluation Ⅱ in cardiac critical care patients

目的评估急性生理和慢性健康状况评价系统Ⅱ(APACHEⅡ)在心血管急重症患者临床评价中的作用。方法连续入选345例心血管急重症住院患者,进行APACHEⅡ评分,同时检测N末端脑钠肽前体(NT-proBNP)、大内皮素等临床相关指标,比较患者院内的预期病死率和实际病死率。结果 345例患者的实际病死率和预期病死率分别为4.93%和7.85%(P>0.05)。受试者工作特征曲线下面积为0.832。单因素回归分析显示,APACHEⅡ评分参数———呼吸频率(OR=1.17,95%CI:1.04～1.31,P=0.01)、血钠浓度(OR=0.90,95%CI:0.81～0.99,P=0.03)、血肌酐浓度(OR=1.01,95%CI:1.00～1.02,P<0.01)、白细胞计数(OR=1.18,95%CI:1.05～1.33,P<0.01)与死亡率相关,而非APACHEⅡ评分因素———总蛋白(OR=0.95,95%CI:0.90～0.99,P=0.04)、白蛋白(OR=0.90,95%CI:0.83～0.99,P=0.02)、谷草转氨酶(OR=1.00,95%CI:1.00～1.01,P<0.01)、谷丙转氨酶(OR=1.00,95%CI:1.00～1.001,P=0.01)、NT-proBNP(OR=1.00,95%CI:1.00～1.01,P=0.02)、大内皮素(OR=1.58,95%CI:1.02～2.45,P=0.01)、是否进行机械通气(OR=178.36,95%CI:19.75～1610.72,P<0.01)亦与病死率相关。多因素回归分析表明,钠值(OR=0.846,95%CI:0.740～0.968,P=0.015)、机械通气(OR=358.7,95%CI:27.2～4731.7,P<0.01)与病死率相关。结论 APACHEⅡ模型对心血管急重症患者的预后有一定的判断作用,但仍有很多不足之处。

Objective To evaluate the use of acute physiology and chronic health evaluation （APACHEⅡ ） in cardiac critical care patients and analyze its deficiencies. Methods A retrospective study was performed in 345 patients admitted to ICU from December 1, 2009 to April 31, 2010. APACHE Ⅱ score was calculated. Expected and actual in-hospital mortality rate was compared. Results The actual death rate was 4. 93% （ n = 17 ）, the predicted death rate was 7.85% , and there was no significant difference between them （ P 〉 0. 05 ）. Univariate regression analysis showed that, for the acute physiology parameters, respiratory rate （ OR = 1.17, 95% CI： 1.04-1.31, P =0.01 ） , Na （ OR =0. 9, 95% CI： 0. 81- 0.99, P=0.03）, Cr （OR=1.01, 95% CI： 1.00-1.02, P〈0.01）, WBC （OR=I. 18, 95%CI： 1.05- 1.33, P 〈0. 01 ） were correlated with death. For other commonly used parameters, total protein （ OR = 0.95, 95%CI： 0.90-0.99, P =0.04）, ALB （OR=0.90, 95% CI- 0.83-0.99, P=0.02）, AST （OR= 1.00, 95%CI： 1.00-1.01, P〈0.01）, ALT （OR=l.00, 95%CI： 1.00-1.001, P=O. 01）, NT-proBNP （OR= 1.00, 95% CI： 1.00-1.01, P=0.02）, Big-ET （OR=1.58, 95%CI： 1.02-2.45, P=0.01）,Mechanical Ventilation （OR = 178.36, 95% CI： 19.75-1610. 72, P 〈 0. 01 ） were correlated with death. And the multivariate regression analysis showed that Na （ OR = 0. 846, 95% CI： 0. 74-0. 968, P = 0. 015 ） and Mechanical Ventilation （ OR =358. 7, 95% CI： 27.2-4 731.7, P 〈0. 01 ） were correlated with death. Conclusions APACHE lI has a certain effect on the prediction of prognosis of cardiac critical care patients, but it has some deficiencies.