肺部感染评分和急性生理学与慢性健康状况评分对COPD急性加重期并2型呼吸衰竭患者预后评估的应用价值

The prognosis value of pulmonary infection score and acute physiology and chronic health evaluation to acute exacerbation of COPD with type 2 respiratory failure

目的：探讨肺部感染评分和急性生理学与慢性健康状况评分对COPD急性加重期并2型呼吸衰竭患者预后评估的应用价值。方法选择2011年2月~2014年2月在我院住院治疗的COPD急性加重期并2型呼吸衰竭患者112例作为研究对象，比较生存组和死亡组患者两种评分方法的分值、两种评分方法不同分值患者实际病死率、两种评分方法对慢性阻塞性肺疾病急性加重期并呼吸衰竭预测死亡率的ROC曲线。结果两组患者PaO2、pH、PaCO2及HCO3-比较差异无统计学意义（t=1.742、1.647、1.791、1.082，P〉0.05）；但死亡组AG和潜在HCO3-指标水平高于生存组（t=10.865、5.993，P〈0.05）；生存组APACHEⅢ、CPIS评分均显著低于死亡组，差异均有统计学意义（t=6.254、4.397，P〈0.05）。APACHⅢ评分≥25和CPIS评分≥6的患者病死率均显著高于低于此值的患者，差异有统计学意义（χ2=10.264、7.351，P〈0.05）。 CPIS预测COPD急性加重期并2型呼吸衰竭死亡率，ROC曲线下面积为0.867，APACHEⅢ预测COPD急性加重期并2型呼吸衰竭死亡率，ROC曲线下面积为0.938。结论 CPIS和APACHEⅢ都对COPD急性加重期并2型呼吸衰竭患者预后评估有一定价值，但APACHEⅢ分辨度更佳，可为病情预测提供参考，值得临床应用推广。

Objective To investigate the prognosis value of pulmonary infection score and acute physiology and chronic health evaluation to acute exacerbation of COPD with type 2 respiratory failure. Methods 112 cases with acute exacer-bation of COPD with type 2 respiratory failure were selected as research subjects in our hospital from February 2011 to February 2014,scores of two scoring methods,actual mortality with different scores of two scoring methods,ROC curve predicted mortality of two scoring methods to chronic obstructive pulmonary disease with acute exacerbation of respira-tory failure of survival group and death group were compared. Results There were no significant differences between the two groups in PaO2、pH、PaCO2 and HCO3-（t=1.742, 1.647, 1.791, 1.082, P〉0.05）;but the levels of AG and poten-tial HCO3-in death group were higher than those in survival group（t=10.865, 5.993, P〈0.05）. APACHEⅢ,CPIS scores of survival group significantly were lower than the death group, the differences were statistically significant （t=6.254,4.397,P〈0.05）. Mortality of APACHⅢ score ≥25 and CPIS score ≥6 were significantly higher than patients with lower than that value, the differences were statistically significant（χ2=10.264,7.351,P〈0.05）. CPIS predict mortality acute exacerbation of COPD with type 2 respiratory failure, the area under the ROC curve was 0.867,APACHEⅢpredict mortality acute exacerbation of COPD with type 2 respiratory failure, the area under the ROC curve was 0.938. Conclusion CPIS and APACHEⅢ has certain prognostic value to acute exacerbation of COPD and type 2 respiratory failure,but APACHEⅢ resolution are better, it can provide a reference for disease prediction, it is worthy of applica-tion and promotion in clinical.