APACHE Ⅱ评分系统在心外科围术期危重症患者的应用价值

APACHE Ⅱ for Severity Evaluation and Prognosis Prediction of Patients Undergoing Cardiac Surgery

目的探讨急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)系统对心外科围术期危重症患者病情危重程度及预后判断的应用价值。方法选取沈阳军区总医院心外科重症监护病房(ICU)2011年12月1日至2013年8月31日收治的3 566例心外科术后患者,其中男1 873例,女1 693例;年龄10 d至82岁,平均(45.8±23.7)岁。对所有患者应用APACHEⅡ评分系统进行评分,并计算患者预计死亡率,采用受试者工作特征(ROC)曲线及预计死亡率及实际死亡率的比较对APACHEⅡ评分的应用价值进行判定。结果生存3 373例,死亡193例,病死率为5.41%。采用ROC曲线评价APACHEⅡ的真实性,ROC曲线下面积为0.917(P=0.000),95%可信区间为[0.885,0.949]。APACHEⅡ的临界点为15.50分,APACHEⅡ系统的灵敏度为80.3%,特异度为95.6%,准确度为79.5%,阳性预测值为86.9%,阴性预测值为93.1%。随着APACHEⅡ评分分值增大,预计病死率及实际死亡率亦增大,两者呈正相关。结论 APACHEⅡ评分系统可较好地评价心外科重症患者病情危重程度及评估预后,为合理利用心外科医疗护理资源提供参考。

Objective To investigate acute physiologic and chronic health evaluation Ⅱ（APACHE Ⅱ） score system for severity evaluation and prognosis prediction of patients undergoing cardiac surgery. Methods A total of3 566 patients who were admitted in ICU after cardiac surgery in the Department of Cardiovascular Surgery of General Hospital of Shenyang Military between December 1, 2011 and August 31, 2013 were enrolled in this study. There were1 873 males and 1 693 females with their average age of 45.8±23.7 years（range, 10 days to 82 years）. All the patients were evaluated with APACHE Ⅱ and expected mortality was calculated. Receiver operating characteristic（ROC） curve was drawn to compare expected and actual mortality and evaluate predictive value of APACHE Ⅱ. Results A total of 3 373 patients survived the operation, and 193 patients died postoperatively with the mortality of 5.41%. The area under the ROC curve was 0.917（P=0.000） with 95% confidence interval of [0.885,0.949]. The cut-off point of APACHE Ⅱ was 15.50,with a sensitivity of 80.3%,a specificity of 95.6%,an accuracy rate of 79.5%,a positive predictive value of 86.9%,and a negative predictive value of 93.1%. Expected and actual mortality increased with increasing APACHE Ⅱ,which were both positively correlated. Conclusion APACHE Ⅱ score system can be used to evaluate severity and predict prognosis of patients undergoing cardiac surgery, which provides reference for rational utilization of ICU resource.