Objective:To explore the easily applicable indicators of practical value to evaluate the prognosis of acute respiratory distress syndrome（ARDS）.Methods:Blood and biochemical tests and bloodgas analyses were performe...Objective:To explore the easily applicable indicators of practical value to evaluate the prognosis of acute respiratory distress syndrome（ARDS）.Methods:Blood and biochemical tests and bloodgas analyses were performed upon entry into the ICUs,12 h,24 h,48 h and 72 h after that in 72 ARDS patients（who were admitted to the ICUs of our hospital from January 2000 to December 2009）.Then APACHEⅡscores were achieved by combining relevant physiological parameters and laboratory results.Results:There was a statistical difference between the death group and survival group at different time points upon entering the ICUs in terms of APACHEⅡscore, alveolar-arterial oxygen difference and arterial blood lactate clearance rate.PaO<sub>2</sub>/FiO<sub>2</sub> values were recorded to be statistically different between the death group and survival group 24 h,48 h and 72 h,respectively after entry into the ICUs.In addition,registered linear regression existed between APACHEⅡscore,alveolar-arterial oxygen difference or PaO<sub>2</sub>/FiO<sub>2</sub> value and time. APACHEⅡscore 24 h and 72 h after entering ICUs predicted mortality with an area under the ROC curve（AUC） standing respectively at 0.919 and 0.9SS.Arterial blood lactate clearance rate 12 h, 24 h,48 h and 72 h after entering ICUs predicted mortality with an area under the ROC curve （AUC） at 0.918,0.918,0.909 and 0.991,respectively.Conclusions:APACHEⅡscore applied in combination with arterial blood lactate clearance rate is of clinical significance in assessing the prognosis of ARDS patients.展开更多
目的评估欧洲心脏手术风险评估系统Ⅱ(European System for Cardiac Operative Risk EvaluationⅡ,Euro SCOREⅡ)预测A型主动脉夹层患者孙氏手术(全主动脉弓置换+支架象鼻手术)后院内死亡及住ICU时间延长的有效性。方法回顾性分析2009年...目的评估欧洲心脏手术风险评估系统Ⅱ(European System for Cardiac Operative Risk EvaluationⅡ,Euro SCOREⅡ)预测A型主动脉夹层患者孙氏手术(全主动脉弓置换+支架象鼻手术)后院内死亡及住ICU时间延长的有效性。方法回顾性分析2009年2月至2012年2月北京安贞医院384例A型主动脉夹层患者的临床资料。急性主动脉夹层228例(59.38%)。根据Euro SCOREⅡ预测术后死亡率将患者分为低危、中危、高危、极高危组。低危组296例(女52例),平均年龄(45.39±10.75)岁;中危组70例(女19例),平均年龄(47.67±11.26)岁;高危组13例(女5例),平均年龄(53.08±4.94)岁;极高危组5例(女1例),平均年龄(41.60±11.08)岁。手术方式均为中度低温停循环+选择性脑灌注下行孙氏手术。采用Euro SCOREⅡ预测患者术后死亡率及住ICU时间延长。结果院内死亡率为8.07%(31/384)。平均住ICU时间为3.06 d,42例住ICU时间≥7 d。对于低危组,Euro SCOREⅡ预测死亡率低于实际死亡率;对于中危、高危、极高危组,预测死亡率高于实际死亡率。Euro SCOREⅡ预测术后死亡、住ICU时间延长的区分度不佳,ROC曲线下面积分别为0.49和0.52,预测术后死亡、住ICU时间延长校正能力亦不佳(P<0.001)。结论 Euro SCOREⅡ对A型主动脉夹层患者孙氏手术后院内死亡及住ICU时间延长的预测效能不佳。目前亟需专门针对A型主动脉夹层手术的风险评估系统。展开更多
目的探讨改良早期预警(modified early warning score,MEWS)评分、快速急诊内科(rapid emergency medicine score,REMS)评分、急性生理学及慢性健康状况Ⅱ(acute physiology and chronic health evaluationsⅡ,APACHEⅡ)评分、简化急性...目的探讨改良早期预警(modified early warning score,MEWS)评分、快速急诊内科(rapid emergency medicine score,REMS)评分、急性生理学及慢性健康状况Ⅱ(acute physiology and chronic health evaluationsⅡ,APACHEⅡ)评分、简化急性生理Ⅱ(simplified acute physiology socreⅡ,SAPSⅡ)评分在老年危重患者中的相关性及对预后评估的准确性。方法分析入选的150例老年危重患者4种评分情况,统计患者治疗后28天病死率,比较死亡组和生存组间各评分之间是否存在差异。并分析4种评分间的相关性及利用受试者工作特征(ROC)曲线探究4种评分对患者预后的评估能力。结果 4种评分在死亡组与存活组间差异具有统计学意义。4种评分间均互呈正相关关系。通过ROC曲线分析显示:4种评分对患者预后均具有一定评估能力。APACHEⅡ评分的评估准确性优于SAPSⅡ、REMS评分、MEWS评分。SAPSⅡ评分评估准确性同样优于REMS评分和MEWS评分。REMS评分和MEWS评分评估准确性相当。结论 4种评分系统对急诊老年患者预后均具有评估意义。急诊早期MEWS评分、REMS评分与ICU病房APACHEⅡ评分、SAPSⅡ评分间对患者预后评估具有一致性。急诊早期可行MEWS评分、REMS评分评估患者病情,对可能预后不良患者早期ICU病房进行分诊,进一步根据不同情况行APACHEⅡ评分和SAPSⅡ评分动态观察、综合评估,同时各评分系统间相互结合与补充,适时采取临床相关干预措施,调整诊疗方案,挽救患者生命。展开更多
基金sponsored by Guangdong Science and Technology Project(No:2009B03081118)
文摘Objective:To explore the easily applicable indicators of practical value to evaluate the prognosis of acute respiratory distress syndrome（ARDS）.Methods:Blood and biochemical tests and bloodgas analyses were performed upon entry into the ICUs,12 h,24 h,48 h and 72 h after that in 72 ARDS patients（who were admitted to the ICUs of our hospital from January 2000 to December 2009）.Then APACHEⅡscores were achieved by combining relevant physiological parameters and laboratory results.Results:There was a statistical difference between the death group and survival group at different time points upon entering the ICUs in terms of APACHEⅡscore, alveolar-arterial oxygen difference and arterial blood lactate clearance rate.PaO<sub>2</sub>/FiO<sub>2</sub> values were recorded to be statistically different between the death group and survival group 24 h,48 h and 72 h,respectively after entry into the ICUs.In addition,registered linear regression existed between APACHEⅡscore,alveolar-arterial oxygen difference or PaO<sub>2</sub>/FiO<sub>2</sub> value and time. APACHEⅡscore 24 h and 72 h after entering ICUs predicted mortality with an area under the ROC curve（AUC） standing respectively at 0.919 and 0.9SS.Arterial blood lactate clearance rate 12 h, 24 h,48 h and 72 h after entering ICUs predicted mortality with an area under the ROC curve （AUC） at 0.918,0.918,0.909 and 0.991,respectively.Conclusions:APACHEⅡscore applied in combination with arterial blood lactate clearance rate is of clinical significance in assessing the prognosis of ARDS patients.
文摘目的探讨改良早期预警(modified early warning score,MEWS)评分、快速急诊内科(rapid emergency medicine score,REMS)评分、急性生理学及慢性健康状况Ⅱ(acute physiology and chronic health evaluationsⅡ,APACHEⅡ)评分、简化急性生理Ⅱ(simplified acute physiology socreⅡ,SAPSⅡ)评分在老年危重患者中的相关性及对预后评估的准确性。方法分析入选的150例老年危重患者4种评分情况,统计患者治疗后28天病死率,比较死亡组和生存组间各评分之间是否存在差异。并分析4种评分间的相关性及利用受试者工作特征(ROC)曲线探究4种评分对患者预后的评估能力。结果 4种评分在死亡组与存活组间差异具有统计学意义。4种评分间均互呈正相关关系。通过ROC曲线分析显示:4种评分对患者预后均具有一定评估能力。APACHEⅡ评分的评估准确性优于SAPSⅡ、REMS评分、MEWS评分。SAPSⅡ评分评估准确性同样优于REMS评分和MEWS评分。REMS评分和MEWS评分评估准确性相当。结论 4种评分系统对急诊老年患者预后均具有评估意义。急诊早期MEWS评分、REMS评分与ICU病房APACHEⅡ评分、SAPSⅡ评分间对患者预后评估具有一致性。急诊早期可行MEWS评分、REMS评分评估患者病情,对可能预后不良患者早期ICU病房进行分诊,进一步根据不同情况行APACHEⅡ评分和SAPSⅡ评分动态观察、综合评估,同时各评分系统间相互结合与补充,适时采取临床相关干预措施,调整诊疗方案,挽救患者生命。
