ICU危重症患者APACHEⅡ评分变化率和临床预后的关系.DOCVIP

ICU危重症患者APACHEⅡ评分变化率和临床预后的关系 刘波1，单南冰 （阜阳市第二人民医院 重症医学科，阜阳 安徽，236000） 【摘要】目的：分析ICU危重症患者APACHEⅡ评分变化率（简称APACHEⅡ变化率）和临床预后的关系。方法：选取ICU收治危重症患者94例作为研究对象并跟踪28d，根据28d生存情况分为生存组（66例）和死亡组（28例）两组，收集第1天APACHEⅡ评分（APACHEⅡ1）、第二天APACHEⅡ评分（APACHEⅡ2）资料，计算APACHEⅡ变化率；对比两组患者之间APACHEⅡ1、APACHEⅡ2和APACHEⅡ变化率的差异；采用ROC曲线的方法比较APACHEⅡ1和APACHEⅡ变化率预测临床预后的差异。结果：死亡组患者APACHEⅡ1、APACHEⅡ2高于生存组，而APACHEⅡ变化率低于生存组，差异显著，具有统计学意义（P＜0.05）；APACHEⅡ变化率和预后呈负相关性（P＜0.05）；ROC曲线结果显示APACHEⅡ变化率预测总体预后的曲线下面积（AUC）为0.880，高于APACHEⅡ1的曲线下面积0.775，差异具有统计学意义（P＜0.05）。APACHEⅡ变化率的最佳界值为0.21（敏感性60.7%，特异性95.5%）。结论：APACHEⅡ变化率对ICU危重症患者临床预后的评估意义高于单纯对APACHEⅡ1的观察。 【关键词】APACHEⅡ评分；APACHEⅡ评分变化率；重症监护病房；预后 Relationship between the variability of APACHEⅡ and prognosis of severe patients from ICU 【Abstract】Objective: To analysis the relationship between the variability of APACHEⅡ and clinical prognosis of severe patients from ICU. Method:94 cases of severe patients from ICU were recruited and followed up for 28 days,all the patients were divided into survival group (66 cases) and death group (28 cases) according to the 28 d survival situation;collect the first day APACHEⅡ score (APACHEⅡ1) and second day APACHE Ⅱ score (APACHEⅡ2) data,calculate the variability of APACHEⅡ.Compare the difference of APACHEⅡ1,APACHEⅡ2 and the variability of APACHEⅡ between two groups.ROC curve method was carried out to compare the difference of APACHEⅡ1 and variability of APACHEⅡ in the assessment of clinical prognosis..Results: The APACHEⅡ1 and APACHEⅡ2 in death group were higher than that of survival group,while the variability of APACHEⅡ was lower than survival group,differences with statistically significant (P0.05).There was negative correlation between variability of APACHEⅡ and prognosis(P0.05);ROC curve showed that the area under the curve (AUC) of the variability of APACHEⅡ when the assessment of overall prognosis was 0.880,higher than that of APACHEⅡ1(0.775),with statistically significant differences (P0.05).The cut-off of the variability of APACHEⅡ was 0.21 (s