APACHE Ⅱ评分在专科ICU危重产科患者病情评估中的应用价值

The application value of APACHE Ⅱ score in the evaluation of ICU in critically ill obstetric patients

目的探讨APACHEⅡ评分(急性生理学与慢性健康状况评分acute physiologyand chronic health evaluation,APACHEⅡ)评分在ICU中危重症产科患者病情预后中的应用价值,病情评估与危重孕产妇病情预后的相关性。方法分析我院2017年1月-2018年5月间收住我科ICU的危重产科患者,主要病因包括产科出血68例(59.65%)、出血量>2000mL 36例(31.58%)、重度子痫前期26例(22.8%)、HELLPE综合征8例(7.02%),甲亢危象2例(1.75%),产后并发急性心力衰竭,心律失常的6例(5.26%)、子痫发作3例(2.63%)、羊水栓塞1例(0.88%)、成功救治孕产妇113例,死亡1例(羊水栓塞)。所有入住ICU患者均应用APACHE-Ⅱ评分系统对其行危重症病情评估,预测患者预后及其病情转归,分析预测预后同实际预后的相关性。结果 APACHE II评分评估预测产科危重患者预后的有效性分析:114例产科危重患者APACHEII评分5～46分; APACHE II评分≤5～10分33例;11～15分51例;16～20分18例;21～25分6例;26～30分4例;30～40分1例;>40分1例。113例生存者评分为(5～31)分;1例死亡者评分最高为46分。随着APACHE II评分的增高,患者实际病死率及预测病死率均有所升高,但实际病死率远低于预测病死率,预测病死率与实际病死率差异有统计学意义(P<0.05)。结论采用APACHEⅡ评分评估产科患者的病情严重程度有一定价值,但不能准确预测并反映ICU产科多器官功能障碍综合征及休克患者的病情;产科患者妊娠期特殊的一些生理性的变化在APACHE II中也给予了分值,但某些能反映产科特异性病理变化的指标却未能在APACHE II的评分中体现,不同危重产科相关并发症在评分中差异没有显著性,使其应用受到一定的局限,期待有更好的危重产科评分方法及改进的评分方法应用于临床。

Objective To investigate the value of APACHE Ⅱ score （acute physiology and chronic health evalu- ation, APACHE Ⅱ） score in the prognosis of critically ill obstetric patients in ICU, and to evaluate the correlation between disease assessment and prognosis of critical maternal disease. Methods Analysis of critically obstetric pa- tients admitted to our department ICU from January 2017 to May 2018. The main causes included 68 cases of obstetric hemorrhage （59.65%）, 36 cases （31.58%） with more than 2000ml, 26 cases （22.8%） with severe preeclampsia, 8 cases （7.02%） with HELLPE syndrome, and 2 cases with hyperthyroidism （1.75%）, postpartum complicated acute heart failure, arrhythmia in 6 cases （5.26%）, eclampsia in 3 cases （2.63%）, amniotic fluid embolism in 1 case （0.88%）, successful treatment of pregnant women in 113 cases, and death in 1 case （ Amniotic fluid embolism）. All patients admitted to ICU were assessed for critical illness by APACHE-II scoring system, predicting prognosis and outcome, and correlating prognosis with actual prognosis. Results APACHE II score assessment for predicting the prognosis of critically ill patients： 114 AVACHE II scores of 5 to 46 patients with critically ill patients; APACHE Ⅱscore ≤ 5-10 points and 33 cases; 11-15 minutes 51 cases; 16-20 minutes 18 cases; 1-25 minutes 6 cases; 1-25 minutes 6 cases; 30-40 minutes 1 case; 〉 40 minutes 1 case. 113 survivors were scored （5-31）; 1 death toll scored up to 46 points. With the increase of APACHE II score, the actual mortality rate and predicted mortality rate of patients increased, but the actual mortality rate was much lower than the predicted mortality rate. The difference between the predicted mor- tality rate and the actual mortality rate was statistically significant （P〈0.05）. Conclusion Using APACHE II score to assess the severity of obstetric patients has certain value, but can not accurately predict and reflect the IGU obstetric multiple organ dysfunction syndrome and the condition of shock patients; Some special physiological changes in obstetric patients during pregnancy are also scored in APACHE II, but some indicators that reflect obstetric-specific pathological changes are not reflected in the APACHE II score. Different critical obstetric complications There is no significant difference in the score, which limits its application, and it is expected that there will be better critical obstetric scoring methods and improved scoring methods for clinical application.