APACHE Ⅱ评分在重症肺炎病人撤机中的预测价值

The predictive value of APACHE Ⅱ scoring in weaning outcome of mechanical ventilation in patients with severe pneumonia

目的:探讨APACHEⅡ评分情况与重症肺炎病人机械通气撤机结局间的关系。方法:重症肺炎并需有创机械通气病人45例,于入院后第1天及达到撤机标准行自主呼吸试验(SBT)前进行APACHEⅡ评分。根据撤机结局分为观察组及对照组,观察组35例为拔除气管插管后48 h不需呼吸机辅助通气者,对照组10例为SBT失败和拔管后48 h内重新插管恢复机械通气者。比较2组入院第1天及撤机前APACHEⅡ评分和SBT前机械通气时间,绘制受试者工作特征曲线(ROC曲线),计算曲线下面积(AUC),评价APACHEⅡ评分对撤机结局的预测价值。结果:2组病人入院第1天APACHEⅡ评分、SBT前通气时间和撤机前APACHEⅡ评分差异均无统计学意义(P>0.05)。APACHEⅡ评分的ROC曲线AUC为0.871,最佳截点值为APACHEⅡ=10.1,此时的敏感度为90.6%,特异度为53.8%。结论:APACHEⅡ评分在预测重症肺炎病人撤机结局有一定价值,可作为撤机参考指标之一。

Objective：To investigate the relationship between APACHE Ⅱ score and weaning outcome of mechanical ventilation in patients with severe pneumonia. Methods ：The APACHE Ⅱ scores of 45 severe pneumonia patients treated with mechanical ventilation were obtained before spontaneous breathing test（SBT） at the first day of admission and according with weaning standard. According to the weaning outcome, the patients were divided into the observation group（ 35 cases） and control group（10 cases）. The observation group did not need ventilator-assisted ventilation after 48 hours of pulling tracheal intubation, and the control group need reintubation to recover ventilator-assisted ventilation within 48 hours of extubation and after the SBT failure. The APACHE Ⅱ score at the first day of admission and before weaning, and mechanical ventilation time before SBT between two groups were compared. The receiver operating characteristic curve （ROC curve） was drew, and the area under curve （AUC） was calculated. The APACHE Ⅱ score was used to predict the weaning outcome. Results： The differences of the APACHE Ⅱ score at the first day of admission, mechanical ventilation time before SBT and APACHE Ⅱ score before weaning between two groups were not statistically significant （ P 〉 0.05 ）. The AUC of the ROC curve of APACHE Ⅱ score was 0.871 ,the best cut-off value was the APACHE Ⅱ for 10.1 ,and the sensitivity and specificity was 90.6% and 53.8% ,respectively. Conclusions ：APACHE Ⅱ score has a certain value in predicting the outcome of severe pneumonia, and can be used as a reference index in weaning of mechanical ventilation.