机械通气患者早期APACHEII评分及血清降钙素原水平与预后的关系

The relationship between early APACHEII score,procalcitonin level and prognosis in patients with mechanical ventilation

目的探讨在呼吸ICU中应用机械通气的危重症患者急诊早期APPACHEII评分及血清降钙素原(PCT)水平对患者预后判断的意义。方法将2016~2017年首都医科大学宣武医院呼吸ICU中应用呼吸机的危重症患者根据患者此次发病是否死亡分为死亡组和生存组两组,其中死亡组病例数为41例,生存组病例数为95例,回顾性研究这两组患者于急诊就诊时初期APPACHEII评分及血清PCT水平,并进行统计学的分析。根据APPACHEII评分及PCT水平绘制受试者工作曲线(ROC曲线),计算APPACHEII评分及PCT水平预测死亡的约登指数,根据约登指数计算患者的敏感度和特异度。结果 APPACHEII评分及血清PCT水平对预后的预测能力分析:根据急诊APPACHEII评分及PCT水平,按照患者分组情况计算并绘制ROC曲线,APPACHEII评分以20.50为截点,曲线下面积为0.704,两组患者数据差异具有统计学意义(P=0.00),95%CI:0.606~0.802(P <0.01),PCT数值以0.375μg/ml为截点,曲线下面积为0.738,两组患者数据差异具有统计学意义(P=0.00),95%CI:0.649~0.826(P <0.01)。136例患者中,APACHEII评分预测死亡的约登指数为20.50,此时敏感度为65.9%,特异度为67.4%;PCT水平预测死亡的约登指数为0.375,此时敏感度为92.7%,特异度为48.4%。结论早期危重症患者在进入急诊后早期进行的APACHEII评分及血清PCT检测,APACHEII评分结果能较好地反映患者病情的严重程度,APACHEII评分具有一定的敏感度和特异度,与之相比,PCT检测具有较好的敏感度,但是特异度不足。因此可以通过急诊早期的APACHEII评分和PCT检测结果结合起来对需呼吸机支持的危重症患者的预后进行预测。

Objective To explore the significance of APPACHEII score and procalcitonin( PCT) value in the early emergency of critically ill patients with mechanical ventilation in respiratory ICU for the prognosis of patients.Methods To breathe the ICU ventilator used in critically ill patients form 2016 ~ 2017 Capital Medical University Xuanwu Hospital according to whether the patients with the disease death was divided into two group death and survival groups,among which the number of cases of death for 41 cases,survival group the number of cases for 95 cases,retrospective study the two groups of patients in emergency department APPACHEII score early and numerical value of PCT,and statistical analysis.The ROC curve was drawn according to APPACHEII score and PCT level,and the Jordan index of APPACHEII score and PCT level for predicting death was calculated.The sensitivity and specificity of patients were calculated according to Jordan index.Results The predictive power of APPACHEII score and PCT value on prognosis was analyzed.According to the emergency APPACHEII score and PCT value,the ROC curve of subjects was calculated and drawn according to the patient grouping.The area under the curve of APPACHEII score was 0.704,95% CI: 0.606 ~0.802( P < 0.01),numerical area under curve of 0.738 PCT,data statistically significant differences in two groups of patients( P = 0.00),95% CI: 0.649~0.826( P < 0.01),on the basis of 0.5,136 cases of patients,the APACHEII about index is 20.50,the sensitivity was 65.9%,and specificity of 67.4%,about PCT values of index is 0.375,the sensitivity was 92.7%,and specificity of 48.4%.Conclusion The results of APACHEII score and PCT examination conducted in early critical patients after emergency treatment can better reflect the severity of the patient’s condition.APACHEII score has certain sensitivity and specificity.Compared with PCT examination,PCT examination has better sensitivity but less specificity.Therefore,the prognosis of critically ill patients requiring ventilator support can be predicted by combining the early APACHEII score and PCT detection results in the emergency department.