APACHEⅡ评分和CAPS评分在慢性阻塞性肺疾病急性加重期合并呼吸衰竭患者预后评估的应用

Application of APACHEⅡ score and CAPS score in prognostic evaluation of patients with AECOPD complicated with respiratory failure

目的探讨急性生理性与慢性健康状况评分（APACHEⅡ评分）和慢性阻塞性肺疾病和支气管哮喘生理评分（CAPS评分）在慢性阻塞性肺疾病急性加重期（AECOPD）合并呼吸衰竭患者预后评估中的应用价值。方法根据预后生存情况将147例AECOPD合并呼吸衰竭患者分为死亡组（46例）和存活组（101例）,回顾性分析2组临床资料,对比2种评分系统内不同分值患者病死率差异,分析其对AECOPD合并呼吸衰竭患者预后的评估价值。结果死亡组有创通气时间及ICU住院时间显著长于存活组,APACHEⅡ评分和CAPS评分显著高于存活组（P〈0.01）。2种评分系统内,得分越高的患者死亡率越高,差异有统计学意义（P〈0.01）。APACHEⅡ评分和CAPS评分预测AECOPD合并呼吸衰竭患者预后存活的受试者工作曲线（ROC曲线）下面积分别为0.874（95%CI为0.809～0.939,P〈0.01）、0.641（95%CI为0.015～0.532,P〈0.05）。结论AECOPD合并呼吸衰竭患者的预后情况与APACHEⅡ评分和CAPS评分密切相关,分值越高死亡率越高;APACHEⅡ评分预测患者生存情况的效能优于CAPS评分。

Objective To explore the value of acute physical and chronic healthy evaluation（ APACHEⅡ） score and chronic obstructive pulmonary disease and bronchial asthma physical score（ CAPS） in the prognostic evaluation of patients with acute exacerbation of chronic obstructive pulmonary disease（ AECOPD） complicated with respiratory failure. Methods A total of 147 patients with AECOPD complicated with respiratory failure were divided into death group（ n = 46） and survival group（ n = 101） according to their prognostic survival status. Clinical data of both groups were retrospectively analyzed,the differences of the mortality of patients with different scores in two different scoring systems were compared,and the evaluation value of the two scoring systems in the prognosis of patients with AECOPD complicated with respiratory failure was analyzed. Results Death group was significantly longer in invasive ventilation duration and hospital stays in ICU and higher in APACHEⅡ and CAPS scores than survival group（ P〈0. 01）. In the two scoring systems,the higher the scores were,the higher the mortality was（ P〈0. 01）. The sizes under receiver operating characteristic（ ROC） curve of APACHEⅡ and CAPS scores in predicting the prognostic survival of patients with AECOPD complicated with respiratory failure were 0. 874（ 95% CI： 0. 809 ～ 0. 939,P〈0. 01） and0. 641（ 95% CI： 0. 015 ～ 0. 532,P〈0. 05） respectively. Conclusion The prognostic conditions of patients with AECOPD complicated with respiratory failure are in closely associated with APACHEⅡand CAPS scores,and the higher the scores are,the higher the mortality is. APACHE Ⅱ score is superior to CAPS score in predicting patients＇ survival conditions.