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目的:研究APACHEⅡ评分在急危重症患者预后判断中的临床应用价值。方法:回顾性分析我院2008年7月至2011年7月纳入的急危重症患者237例。分别于入院后24,48,72h对每位患者进行APACHEⅡ评分及恶化危险性预测。且计算各分数段及总体的阳性率和敏感率验证预测结果的有效性。结果:①恶化组评分显著高于好转组(P<0.01)。肺部感染APACHEⅡ评分均高于其他组(P<0.05)。心血管与脑血管疾病组48h内评分无显著差异,72h两组间评分有显著性差异(P<0.05)。②各分段间预测病死率均有显著差异(P<0.01)。评分值>25时,实际和预测病死率分别为70.3%和(84.1±7.6)%;评分与实际病死率有显著正相关(P<0.01),与预测病死率亦呈显著正相关(P<0.01)。结论:APACHEⅡ评价系统在急危重症预后判断中具有一定临床指导意义,当有APACHEⅡ评分值增高时,应对患者给予加强治疗。
Objective: To study the clinical value of APACHEⅡscore in the prognosis of critically ill patients. Methods: A retrospective analysis of our hospital from July 2008 to July 2011 included 237 cases of critically ill patients. The APACHE II score and the risk of exacerbation were estimated for each patient 24, 48, 72 h after admission. And calculate the fractional and overall positive rate and sensitivity to verify the validity of the prediction results. Results: ① The score of the worsened group was significantly higher than that of the improved group (P <0.01). APACHE Ⅱ score of pulmonary infection were higher than other groups (P <0.05). There was no significant difference between 48h and 48h in cardiovascular and cerebrovascular disease groups, and there was a significant difference between the two groups in 72h (P <0.05). (2) There was a significant difference in predictive mortality among the segments (P <0.01). The actual and predicted case fatality rates were 70.3% and 84.1 ± 7.6% respectively when the score was> 25. The score was positively correlated with the actual case fatality rate (P <0.01) and positively correlated with the predicted case fatality rate (P < 0.01). Conclusion: The APACHE Ⅱ evaluation system has certain clinical significance in judging the prognosis of acute critically ill patients. Patients with intensive care should be treated when APACHE Ⅱ score increases.