APACHE Ⅱ评分及血乳酸清除率在呼吸衰竭患者病情及预后评估的研究

Evaluation of APACHE Ⅱ score and blood lactate clearance rate in patients with respiratory failure and prognosis

目的探究急性生理与慢性健康评分Ⅱ(APACHE Ⅱ)及血乳酸清除率在呼吸衰竭患者病情及预后评估的作用。方法回顾性分析我院2017年3月-2018年3月收治的呼吸衰竭患者86例,将其中55例存活者分为对照组,31例死亡者分为观察组。对比两组不同时间APACHE Ⅱ评分、血气指标及血乳酸清除率,并做可靠性分析。结果观察组各时间点的APACHE Ⅱ评分均高于对照组,A-aDO2高于对照组,PaO2/FiO2低于对照组,差异有统计学意义(P<0.05);观察组各时间点的血乳酸清除率高于对照组,差异有统计学意义(P<0.05);ROC分析显示72h时以APACHE Ⅱ评分为22.365分为截点值得APACHE Ⅱ评分评估呼吸衰竭患者病情的敏感性、特异性分别为84.8%和80.0%,曲线下面积为0.834(P<0.001),以血乳酸清除率的值是25.365%为截点值得乳酸清除率评估呼吸衰竭患者病情的敏感性、特异性分别为74.2%和80.0%,曲线下面积为0.831(P<0.001)。结论 APACHE Ⅱ评分及血乳酸清除率在呼吸衰竭患者病情及预后评估中有较高的可靠性,可作为重要的参考指标。

Objective To explore the role of acute physiology and chronic health score Ⅱ(APACHE Ⅱ)and blood lactate clearance rate in the evaluation of the condition and prognosis of patients with respiratory failure.Methods A retrospective analysis was made on 86 patients with respiratory failure admitted to our hospital from March 2017 to March 2018.55 survivors were divided into control group and 31 deaths were divided into observation group.APACHE Ⅱ score,blood gas index and blood lactate clearance rate were compared between the two groups at different times,and reliability analysis was made.Results The APACHE Ⅱ score of the observation group at each time point was higher than that of the control group,the A-aDO2 of the observation group at each time point was higher than that of the control group,and the PaO2/FiO2 was lower than that of the control group(P<0.05);the blood lactate clearance rate of the observation group at each time point was higher than that of the control group(P<0.05);ROC analysis showed that 72 hby APACHE Ⅱ score of 22.365 is divided into the cutoff point worth APACHE Ⅱ score evaluation of respiratory failure patients of sensitivity and specificity were 84.8%and 80.0%respectively,the area under the curve is 0.834(P<0.001),blood lactate clearance value is 25.365% for cutoff point worth lactate clearance evaluation of patients with respiratory failure condition of the sensitivity and specificity were 74.2% and 80.0%respectively,the area under the curve is 0.831(P<0.001).Conclusion APACHE Ⅱ score and blood lactate clearance rate have high reliability in evaluating the condition and prognosis of patients with respiratory failure,and can be used as an important reference index.