两种评分系统对慢性阻塞性肺疾病急性加重期患者病情严重程度及预后评估的研究

Research on values of two scoring systems in severity and prognostic evaluation for patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)及慢性阻塞性肺疾病和支气管哮喘生理评分(COPD and asthma physiology score,CAPS)与病情严重程度及预后的关系及评估价值。方法回顾性分析2013年1月至2018年11月于北京积水潭医院呼吸与危重症医学科住院治疗的AECOPD患者239例。根据住院期间有无机械通气分为无机械通气组和机械通气组;根据预后分为存活组和死亡组。住院后计算APACHEⅡ评分及CAPS评分。进行两种评分系统的不同组间比较;进行两种评分系统与住院期间需要行机械通气的可能性及疾病转归的相关性分析;评估入院时两种评分系统对住院期间需要行机械通气的可能性及死亡发生风险的预测价值。结果①AECOPD无机械通气组患者两种评分均明显低于机械通气组[APACHEⅡ分别为(12.09±3.48)分、(18.74±4.06)分,CAPS分别为(18.70±5.70)分、(26.35±7.87)分,P<0.05];②AECOPD存活组患者两种评分均明显低于死亡组[APACHEⅡ分别为(13.88±4.06)分、(20.86±4.43)分,CAPS分别为(19.66±5.37)分、(32.84±6.74)分,P<0.05];③Spearman相关分析显示,AECOPD患者APACHEⅡ评分、CAPS评分与住院期间需要行机械通气的可能性均呈显著相关(r值分别为0.694、0.525,P<0.05);④Spearman相关分析显示,AECOPD患者APACHEⅡ评分、CAPS评分与死亡发生风险均呈显著相关(r值分别为0.554、0.612,P<0.05)。结论AECOPD患者入院时APACHEⅡ评分及CAPS评分与病情严重程度及预后密切相关;对于评估患者病情严重程度、住院期间需要行机械通气的可能性,APACHEⅡ评分优于CAPS评分;两者对于AECOPD患者预后的预测价值基本相当,均具有较高的预测价值。

Objective To explore the relationship between APACHEⅡ/CAPS and the severity and prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease and the evaluation value.Method The clinical data of 239 hospitalized cases of AECOPD from January 2013 to November 2018 were retrospectively analyzed.All patients were divided into the following groups:nonventilation group,ventilation group;survival group and fatal group.APACHEⅡand CAPS were calculated after hospitalization.Two scoring systems were compared between different groups.Correlations of two scoring systems with using of ventilation and occurrence of death in AECOPD patients were analyzed.The prognostic value of two scoring systems for AECOPD patients was explored.Result①Two scoring systems in non-ventilation group were significantly lower than in ventilation group(APACHEⅡ:12.09±3.48 vs 18.74±4.06;CAPS:18.70±5.70 vs 26.35±7.87,P<0.05).②Two scoring systems in survival group were significantly lower than in fatal group(APACHEⅡ:13.88±4.06 vs 20.86±4.43;CAPS:19.66±5.37 vs 32.84±6.74,P<0.05).③Spearman correlation analysis showed that,APACHEⅡand CAPS were significant correlated with using of ventilation(r was 0.694,0.525,P<0.05).④Spearman correlation analysis showed that,APACHEⅡand CAPS were significant correlated with occurrence of death(r was 0.554,0.612,P<0.05).Conclusion APACHEⅡand CAPS were significant associated with the severity and prognosis for patients with AECOPD.APACHEⅡwas better than CAPS for evaluating the severity for patients with AECOPD.The prognostic values of two scoring systems for patients with AECOPD were basically the same.