APACHE Ⅱ评分系统对ICU多发伤病例的预后评估

Prediction of outcome by APACHEⅡscoring system for multiple trauma patients in ICU

目的 探讨AcutephysiologyandchronichealthevaluationⅡ (APACHEⅡ )评分系统预测ICU多发伤病人预后的可靠性。方法 回顾性分析总结 1 998年 8月～ 2 0 0 0年 7月我院创伤ICU收治的 1 98例创伤病例的临床资料 ,分析APACHEⅡ分值与其死亡率的关系 ;按系统要求计算每例伤员的死亡概率 ,以死亡概率5 0 %作为临界值预测每例伤员的预后并与实际预后比较。结果 伤员死亡率随着APACHEⅡ分值的增加而升高 ,死亡组APACHEⅡ分值明显高于存活组 (P <0 .0 1 ) ,预测死亡概率与实际死亡率比较差别无显著性意义 (P >0 .0 5 ) ,但在不同的APACHEⅡ分值分组内预测死亡率与实际死亡率吻合度较差 ,以死亡概率 5 0 %作为临界值预测病人预后时 ,其敏感性、特异性和诊断符合率分别为 2 6 .92 %、98.83%、89.39%。结论 A PACHEⅡ评分系统可以较准确地评估群体ICU多发伤病例的预后 。

Objective To evaluate the significance of prediction of APACHEⅡscoring system in ICU multiple trauma patients. Methods The clinical data of 198 patients admitted in our ICU from August 1998～July 2000 were studied retrospectively. The relationship between the mortality and the APACHEⅡ scores was analyzed. The death risk of the patients was calculated according to the recommendation of the APACHEⅡscoring system provider. Using 50 per cent risk of death as a cut off value,the predicited outcomes was compared with that of the observed ones. Results The increase of observed mortality follows the increase of the APACHEⅡscores. The mean APACHEⅡscore of the non-survivors was higher than that of survivors(P<0.01). There was no obvious difference between predicted mortality and observed mortality(P> 0.05) ,but poor agreement between predicted mortality and observed mortality was observed in groups of various APACHEⅡ scores and, using the decision criterion of 50 per cent,the sensitivity specificity and the correct classification rate of the system were 26.92% 98.83% 89.39% respectively. Conclusion The APACHEⅡscoring system is able to predict the prognosis of a group of multitrauma patients correctly,but is not applicable to individual one.