腹部外科危重病人APACHEⅡ应用和救治体会

APACHEII application in critical patients in abdominal surgery and clinical experience

目的 探讨APACHEⅡ评分系统在腹部外科危重病人中的应用价值 ,总结腹部外科继发MODS危重病人的救治经验。方法 回顾性分析 86例APACHEⅡ评分 >2 0分的腹部外科病人的病历资料 ,评定入选病人的脏器衰竭情况 ,计算全组病人MODS的发生率 ,比较继发和未继发MODS病人的死亡率。结果 全组病人死亡率 6 3.95 % ;继发MODS病人死亡率 70 .1 5 % ;未继发MODS病人死亡率 4 2 .1 1 % ;两者相比有显著性差异 (P <0 .0 5 )。结论 APACHEⅡ评分 >2 0分病人属危、重病人 ,预防和治疗MODS是改善腹部外科危重病病人预后的关键。肺脏是MODS发生最早和最常见器官 ,适时的机械通气可望改善危重病人的预后 。

Objective To inquire the value of APACHEⅡ scoring system and summarize the clinical experience for critical patients following MODS in abdominal surgery.Methods Eighty six cases whose APACHEⅡ scores were above 20 marks in abdominal surgery were analyzed retrospectively. The rate of MODS in all patients was calculated and morbidity was compared between the group following MODS and the group not following MODS.Results Results Mortality of all patients was 63.95% . Mortality of the patients following MODS was 70.15% , while that of the patients not following MODS was 42.11% . There were significant differences between the two groups.Conclusion The cases whose APACHEⅡ scores were above 20 marks were critical patients. Prevention and treatment of MODS are critical for improving prognosis of critical patients in abdominal surgery. The lung is the earliest and commonest organ which developed MODS. Mechanical ventilation maybe improve prognosis of critical patients. Nutrient support can strengthen the efficacy of treatment.