APACHEⅡ评分与血乳酸水平对ICU多发伤患者预后的评估应用

Application of APACHEⅡ Scoring System and Blood Lactic Acid level in Evaluating Multiple Trauma Patients in ICU

目的：探讨多发伤患者入院24h内生理学与慢性健康状况评分II（APACHEII）、血乳酸水平的相关性及对预后的评估价值。方法：检测多发伤患者62例血乳酸水平，行APACHEII评分，并按APACHEⅡ评分分为A组（11～20分）、B组（21～30分）、C组（〉30分），根据患者预后分为存活组和死亡组，分析血乳酸水平与APACHEII评分的关系。结果：B、C组血乳酸水平明显高于A组（P〈0．01），C组血乳酸水平明显高于B组（P〈0．05）。存活组血乳酸水平（2．8±1．3）mmol／L，死亡组血乳酸水平（6．0±2．1）mmol／L，两组比较差异有统计学意义（P〈0．05）；62例患者APACHEII评分（19．0±3．7）分，存活组APACHEII评分（15．4±4．3）分，死亡组APACHEⅡ评分（27．6±3．8）分，两组比较差异有统计学意义（P〈0．05）。APACHEⅡ评分与血乳酸水平呈正相关（r=0．585，P〈0．01）。结论：多发伤患者血乳酸水平与APACHEⅡ评分有相关性，对判断病情及预后有重要意义。

Objective：To explore the relationship between acute physiology and chronic health evaluation I I （APACHE Ⅱ） Score and blood lactic acid level and the prognosis of patients admitted to Intensive Care Unit within 24 hours. Methods： The blood lactic acid levels were measured in 62 cases, APACHE II Score was as- sessed, The patients were divided into group A（ll - 20分）、group B（21 - 30分）and group C（ 〉30分）accord- ing to APACHE II scores. All the patients were divided into two groups based on their prognosis： survival group and death group. The relationships between APACHE II score and blood lactic acid level and prognosis were ana- lyzed. Results： The blood lactic acid level was the highest in group C, than in group B and group A（P 〈 0.05）. The blood lactic acid level （2.8 ＋ 1.3） mmol/L in the survival group was significantly lower than （6.0 ± 2.1） mmol/L in the dead group（P 〈 0.05）. The average APACHE II scores of 62 cases was （19.0 ± 3.7） scores. The APACHE II score in the survival group was （15.4 ± 4.3） scores, which was significantly lower than（27.6 ± 3. 8）scores in the dead group（P〈 0.05）. The level of blood lactic acid was positively related to APACHE II score （r = 0. 585, P 〈 0.01）. Conclusion： Blood lactic acid level of patients in dead group was consistent with A- PACHE II multiple trauma patients, which plays all important role in judging the conditions and prognosis of pa-tients admitted to ICU.