APACHEⅡ评分在急性心肌梗死中的临床意义

Clinical significance of APACHE Ⅱ score in patients with acute myocardial infarction

目的 探讨APACHEⅡ评分在急性心肌梗死患者危险分层中的临床意义.方法 2011年1月至2012年12月我院心内科连续住院资料完整的急性心肌梗死患者142例,入院24h进行APACHEⅡ评分并分组,比较高危组（34例）与低危组（108例）1年内随访的差异.结果 高危组年龄显著较低危组大,分别为（78.9±8.1）岁与（65.8±10.2）岁（t=6.835,P＜0.001）,高危组心功能KillipⅢ级和Ⅳ级患者比低危组多,分别为10例（29.4％）与2例（1.8％）,6例（17.6％）与0例（x2值分别为21.950、15.777,P均＜0.05）,肌酸激酶同工酶和肌钙蛋白Ⅰ的峰值高危组较低危组高,分别为（147.7±21.5） U/L与（105.5±17.6） U/L,（42.9±6.3）μg/L与（36.5±5.4） μg/L（t值分别为11.541、5.785,P均＜0.001）,心脏事件（心力衰竭、恶性心律失常,非致死性心肌梗死和任何原因的死亡）的发生率高危组比低危组高,分别为58.8％（20/34）与29.6％（32/108）,47.0％（16/34）与3.7％ （4/108）,17.6％ （6/34）与6.4％ （7/108）,17.6％（6/34）与6.4％ （7/108）,差异均有统计学意义（x2值分别为8.274、36.665、3.876、3.876,P均＜0.05）.结论 APACHEⅡ评分可以作为一种简单、可靠、实用的急性心肌梗死患者危险分层方法用于临床.

Objective To explore the clinical significance of APACHE Ⅱ score on risk stratification in patients with acute myocardial infarction.Methods One hundred and forty-two patients with acute myocardial infarction were included in the study who were admitted to hospital consecutively from Jan.2011 to Dec.2012.High risk group and low risk group were divided by the APACHE Ⅱ score.Some clinical variables at the first 24 h after admitted to hospital and occurring during the following 1 year were recorded Results The age in high risk group was 78.9 ±8.1,significantly higher than that in low risk group （65.8 ± 10.2;t =6.835,P 〈 0.001）.The cases with Killip Ⅲ and Ⅳ in high risk group were 10（29.4%） and 2（1.8%）,lower than in low risk group （6 （1.8%） and 0 （0%） ; x2 =21.950,15.777 ; P 〈 0.005）.The level of creatine kinase-MB （CK-MB） and cardiac troponin Ⅰ in high risk group were （147.7 ±21.5） U/L and （105.5 ± 17.6） U/L,higher than in low risk group（（105.5 ± 17.6） U/L,（42.9 ± 6.3） U/L; t =11.541,5.785 ; P 〈 0.001）.The incidence of severe cardiac events（malignant arrhythmia,heart failure,non fatal myocardial infarction and death from any cause in high risk group were 58.8% （20/34）,47.0% （16/34）,17.6% （6/34） and 17.6% （6/34）,higher than in low risk group （29.6% （32/108）,3.7% （4/108）,6.4% （7/108） and 6.4% （7/108） ; x2 =8.274,36.665,3.876 and 3.876 ; P 〈 0.05）.Conclusion APACHE Ⅱ score is likely to be a simple and practical tool for risk stratification in patients with acute myocardial infarction.