APACHE Ⅳ评分评估重型颅脑损伤预后的价值

APACHE Ⅳ in predicting prognosis of severe traumatic brain injury

目的探讨急性生理学及慢性健康状况评分第4版(APACHEⅣ)评估重型颅脑损伤预后的价值。方法采用前瞻性研究方法,选取115例重型颅脑损伤患者,对患者的APACHEⅣ评分与APACHEⅢ评分结果进行对比研究,分析APACHEⅣ评分在重型颅脑损伤预后评估中的价值。结果 APACHEⅣ评分显著高于APACHEⅢ评分,且死亡患者与存活患者的APACHEⅣ评分结果比较差异有统计学意义,死亡与存活患者APACHEⅢ评分结果比较差异有统计学意义;APACHEⅣ评分系统的预测病死率显著低于APACHEⅢ评分系统。根据受试者操作特征曲线(ROC),APACHEⅣ评分ROC曲线下面积(AUC)为0.867±0.028,显著高于APACHEⅢ评分(0.805±0.028),APACHEⅣ评分标准化死亡比值(SMR)为1.142,对病死率低估,且APACHEⅣ评分的灵敏度较APACHEⅢ评分高,达到79.72%。结论 APACHEⅣ评分在重型颅脑损伤病死率预测中的准确度高及评估效能显著优于APACHEⅢ评分系统,在总体患者预测病死率中存在低估。

Objective To discuss the acute physiology and chronic health evaluation version 4 （APACHE IV） in assess the prognostic value of traumatic brain injury. Methods Using prospective studies method, 115 cases of severe traumatic brain injury patients were selected, all patients with APACHE Ⅳ grade and with APACHE m comparing with the results of research, analysis of APACHE Ⅳ grade value in the evaluation of prognosis of severe traumatic brain injury. Results APACHE Ⅳ score was significantly higher than the APACHE Ⅱ score, and death patients with survival of patients with APACHE Ⅳ scoring results more significant difference, death and survival in patients with APACHE m rating result was significant difference. APACHE Ⅳ scoring system predicts mortality was significantly lower than the APACHE Ⅲ rating system. According to the receiver operating characteristic curve （ROC） curve, APACHE Ⅳ scoring area under the ROC curve （AUC） is 0. 867 ± 0.028, significantly higher than the APACHE Ⅲ score（0. 805 ±0.028 ） ,APACHE Ⅳ grade standardized death ratio （SMR） is 1. 142,the mortality is underestimated, and APACHE Ⅳ grade is with higher sensitivity compared by APACHEⅢ score, and was up to 79. 72%. Conclusion APACHE Ⅳ score in severe traumatic brain injury mortality prediction has higher accuracy and evaluation of effectiveness significance is superior to the APACHE Ⅱ rating system,but the overall mortality prediction is undervalued.