APACHE Ⅱ评分在ICU铜绿假单胞菌下呼吸道感染患者中的应用

Application of the acute physiology and chronic health evaluation Ⅱ score system to patients with infection of Pseudomonas aeruginosa in lower respiratory tract in intensive care unit

目的 :应用急性生理学及慢性健康状况评分 (acute physiology and chronic health evaluation ,APACHE )系统评估重症监护病房 (intensive care unit,ICU )中铜绿假单胞菌 (PA)下呼吸道感染患者的疾病的危重程度、感染治疗效果、入住 ICU时间和预后。方法 :对比观察入住 ICU并且合并下呼吸道 PA感染的12 2例患者 ,按 Knaus法进行 APACHE 评分 ,并进行临床对比。结果 :全部患者共死亡 2 9例 ,APACHE 分值为 (18.78± 7.13)分 ;未死亡者 93例 ,APACHE 分值为 (11.70± 5 .79)分 ,两者差异显著 (t=5 .4 3,P<0 .0 1)。合并感染者较非合并感染者 APACHE 评分高〔(14 .76± 6 .89)分比 (10 .0 8± 6 .14 )分 ,P<0 .0 1〕,预后差 (2 7.91%比 13.89% ,P<0 .0 1) ;重症肺炎患者较非重症肺炎患者 APACHE 评分高〔(15 .5 7± 6 .97)分比(11.81± 6 .0 3)分 ,P<0 .0 1〕,预后差 (39.2 2 %比 12 .6 8% ,P<0 .0 1)。随 APACHE 分值的升高 ,患者的重症肺炎例数增多 ,感染治疗效果差 ,病死率升高 ;预计病死率和实际病死率均与 APACHE 分值呈显著正相关 ,APACHE 分值以 5分阶增加时 ,实际和预计病死率亦增加 ,预测死亡概率的敏感性和阳性率分别为10 0 .0 0 %和 86 .72 %。结论 :在 PA下呼吸道感染的 ICU患者中 ,APACHE ?

Objective: To predict the infection and evaluate the severity of illness and prognosis for patients with infection of Pseudomonas aeruginosa (PA) in lower respiratory tract in intensive care unit (ICU) with the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ). Methods: The clinical data of 122 cases with infection of PA in lower respiratory tract were compared and studied. These data were evaluated with APACHEⅡ score system according to Knaus method. Results: APACHEⅡ scores of the 29 nonsurvivors were significantly higher than that of 93 survivors (18.78±7.13 vs. 11.70±5.79, t=5.43, P<0.01). The patients with coinfections other than PA had a higher APACHEⅡ score (14.76±6.89 vs. 10.08±6.14, P<0.01), a higher mortality (27.91 percent vs. 13.89 percent, P<0.01), and more days of stay in ICU 〔(28.47±23.59)days vs. (16.64±21.19)days〕 than those without. Patients with severe pneumonia had higher APACHEⅡ scores (15.57±6.97 vs. 11.81±6.03) and poorer prognosis (39.22 percent vs. 12.68 percent) than those without. For all patients, when the APACHEⅡ scores became higher and higher, the outcome became poorer and poorer, and the mortality higher and higher, and the percentage of severe pneumonia higher and higher.There was a significant correlation between APACHEⅡscore and actual mortality ( r=0.75, P<0.01) and predicted mortality (r=0.81, P<0.01). Actual and predicted mortality increased along with the increase in APACHEⅡ scores by 5 scores. The sensitivity and positive rate of predicted mortality was 100.00 percent and 86.72 percent respectively. Conclusion: APACHEⅡ score system is highly valuable in predicting the infection and evaluating the severity of illness and prognosis in patients with infection of PA in lower respiratory tract in ICU.