APACHEⅡ评分对心脏大血管外科术后患者病情与预后的评估

Illness severity and prognosis assessment with acute physiology and chronic health evaluation Ⅱ for patients after cardiovascular surgery

目的：探讨急性生理改变及慢性健康评估综合评分系统II（APACHEII）在心脏大血管外科术后患者病情及预后评估中的应用价值。方法：对234例心脏大血管手术患者在人心脏外科重症监护室后的24h内用APACHEII评估其危重程度及预后，并进行统计学相关分析。结果：234例心脏直视术后患者APACHEII得分为（12．88±3．97）分；不同转归分组的APACHEII评分之间差异有统计学意义（P〈0．05）；不同术前心功能分组的APACHEII评分之间差异有统计学意义（P〈0．05）；APACHEII评分与住院时间呈正相关；APACHEII评分系统的ROC曲线下面积为0．991±0．006；以死亡概率〉30％作为预测标准，APACHEII评分系统对死亡危险度预测的灵敏度是80．00％，特异性是99．12％；将APACHEII得分按〈10分、10～20分、〉20分进行分组，仅〉20分组预测病死率在实际病死率95％可信区间内。结论：APACHEII评分系统是评估心脏大血管外科术后患者病情危重程度及预后的良好指标，可以为临床实施分级监测提供依据与参考。

Objective： To evaluate illness severity and to assess the prognosis with acute physiology and chronic health evaluation II （APACHE II） for patients after cardiovascular surgery. Methods： APACHE II scores of 234 patients in the cardiac surgical intensive care unit （CSICU） were calculated, and the actual mortality and the predicted mortality were obtained based on the score. Results： The APACHE II score of the 234 patients was 14.22±6.77. The difference in the APACHE II score between the survivors, the patients with complications and the death group was significant; the difference in the APACHE II score between patients with different preoperative cardiac functions was significant; the detention time in the CSICU was positively related to APACHE II scores; and the ROC area under the curve of APACHE 11 was 0.991±0.006. With the as the standard for death, sensitivity of APACHE II score for mortality risk prediction was 80.00%, specificity was 99.12%, and the accuracy was 98.72%. According to the score, we divided the patients into 3 groups （〈10 points, 10-20 points, 〉20 points）, forecast mortality in the 〉20 point group was in the 95% confidence interval of actual mortality. Conclusion： APACHE II is a good index for illness severity and prognosis assessment for patients after cardiovascular surgery.