APACHEII评分与心搏骤停后综合征患者预后的相关性探讨．

Association of APACHE II scores and the prognosis of patients with post cardiac arrest syndrome

目的探讨APACHEⅡ评分与心搏骤停后综合征（PCAS）患者预后的相关性，为临床预测PCAS患者预后提供有价值的工具。方法选择2011年1月～2015年1月吉林大学第一医院ICU收治的PCAS患者62例。统计其入院24h、72h的APACHEⅡ评分，出院时存活和脑功能恢复情况。对比不同预后患者的入院24h、72hAPACHEⅡ评分之间的差异，利用受试者工作特征曲线（ROC）评价APACHEⅡ评分对PCAS患者预后的预测价值。结果①存活出院23例（37．10％），其中11例（17．74％）具有良好神经学预后。存活组和死亡组患者的人院24hAPACHEH评分相比（P=O．005）、入院72hAPACHEⅡ评分相比（P〈0．001）差异均有统计学意义。存活组患者的入院24h与人院72hAPACHEⅡ评分相比差异有统计学意义（P〈0．0001），而死亡组患者不同时间的APACHEⅡ评分相比差异无统计学意义（P=0．159）。脑功能良好组和不良组患者人院24hAPACHEⅡ评分相比差异无统计学意义（P=0．387），而两组患者入院72hAPACHEⅡ评分相比差异有统计学意义（P〈O．001）。②入院24h、72hAPACHEⅡ评分预测患者生存结局的ROC曲线下面积（AUC）分别为0．691（95％CI=0．558～0．823）、0．875（95％CI=0．770～0．980），入院24h、72hAPACHEⅡ评分预测患者脑功能恢复预后的ROC曲线下面积（AUC）分别为0．516（95％CI=0．338～0．694）、0．804（95％CI=0．669～0．939）。结论PCAS患者的入院24hAPACHEⅡ评分越高可能代表生存结局的预后越差，但并不能预测PCAS患者出院时的神经学预后；入院72hAPACHEⅡ评分的快速下降往往提示PCAS患者有较好的病情转归，其对PCAS患者的生存结局和神经学预后均有较好的预测价值。

Objective To investigate the association of APACHE Ⅱ scores and the prognosis of patients with post cardiac arrest syndrome （PCAS）. Methods A total of 63 PCAS patients were enrolled in the current studywho were admitted into our hospital from January 2011 to January 2015. They were scored according to APACHE Ⅱ 24 hours and 72 hours after admission. They were also assessed their survival and recovery of brain function before discharge. Then, patients with different prognosis were compared for their APACHE Ⅱscores at 24 hours and 72 hours. Then, the prognosis of PCAS patients were predicted using APACHE Ⅱ scores based on receiver operating characteristic （ROC） curve. Results Among all patients were 23 ones who survived （37.10%）, including Ⅱ patients （17.74%） with good neurological prognosis. There were significant differences in APACHE Ⅱ scores 24 hours or 72 hours after admission between the survival group and the non＇survival group （P =0.005 and P 〈0.001, respectively）. Patients in the survival group showed remarkably different APACHE Ⅱscores after admission for 24 hour and 72 hours （P 〈 0.0001）. In contrast, patients in the non-survival group did not produce markedly different APACHE Ⅱscores at different time points （P =0.159）. No significant difference was found in APACHE Ⅱ scores between patients with good and poor brain function 24 hours after admission （P = 0.387）, in spite of significant difference 72 hours after admission （P〈0.001）. The AUC of ROC to predict the survival of the patients based on APACHE Ⅱ scores 24 hours and 72 hours after admission was 0.691 （95% CI = 0.558-0.823） and 0.875 （95% CI = 0.770- 0.980）, respectively. The AUC of ROC to predict the neurological outcome of the patients based on APACHE Ⅱ scores 24 hours and 72 hours after admission was 0.516 （95% CI=0.338-0.694） and 0.804 （95% CI=0.669-0.939）, respectively. Conclusions Higher APACHE Ⅱ scores in PCAS patients 24 hours after admission may predict a worse survival outcome, rather than neurological prognosis before discharge. A rapid decline of APACHE II scores 72 hours after admission tends to show an improved prognosis, which can be adopted to evaluate the survival and neurological outcomes of PCAS patients.