摘要
目的探讨急性生理和慢性健康评价Ⅱ(APACHEⅡ)评分和序贯器官衰竭估计(SOFA)评分对老年危重患者的预后评价作用。方法选取2005年1月至12月收治年龄≥65岁、至少有2个系统功能障碍的患者106例,计算入住 ICU 当日的 APACHEⅡ评分和 SOFA 评分,并且每隔48 h 计算 SOFA 评分直到离开 ICU。按转归分为存活组(72例)和死亡组(34例),比较两组患者APACHEⅡ评分和 SOFA 评分;观察患者入院2周内 SOFA 评分的动态变化;判断 APACHEⅡ和SOFA 评分系统的预测分辨力及校准力。结果存活组的 APACHEⅡ分值和 SOFA 分值均低于死亡组,差异有统计学意义(P<0.01)。存活组在进入 ICU 2周内 SOFA 分值逐渐下降,而死亡组则逐渐增高,两组的变化有统计学意义(P<0.01)。APACHEⅡ和 SOFA_(初始)评分经相关分析,r 值为0.551,P 值为0.00。APACHEⅡ评分预测死亡率的工作特征曲线下面积为0.77,SOFA_(初始)、SOFA_(48h)、SOFA_(96h)、△SOFA、SOFA_(最大)预测死亡率的工作特征曲线下面积分别为0.73、0.90、0.95、0.98、0.99。APACHEⅡ评分的 Lemeshow-Hosmer 值为7.22,差异无统计学意义(P>0.05)。结论 APACHEⅡ评分及连续应用 SOFA 评分能够准确判断老年内科危重患者疾病的严重程度和预后,其中 SOFA_(最大)评分和△SOFA 评分的预测能力最佳。联合应用 APACHEⅡ评分和 SOFA 评分对老年危重患者进行病情评价,可提高预测的准确性。
Objective The aim of this study was to investigate the prognostic value of acute physiological and chronic health evaluation Ⅱ （APACHE Ⅱ ） and sequential organ failure assessment （SOFA） scores in the elderly critical patients. Methods Totally, 106 patients over 65 years old with dysfunction of at least two systems were recruited from the intensive care unit （ICU） of the Internal Medicine Department of the First Hospital of Peking University in Beijing during January to December 2005. The patients were divided into two groups, survivors （72 case） and non-survivors （34 cases） according to their come-off. The APACHE Ⅱ score was estimated for each of the patients at his/her admission, and the SOFA score was estimated at his/her admission and every 48 hours until he/she left ICU. The APACHE Ⅱ and SOFA scores were compared between the two groups and dynamic change in the SOFA scores during the first two weeks hospitalized at ICU was observed. Correlation of APACHE Ⅱ with SOFA scores was analyzed. Areas under receiver operating characteristic curves （aROC） were calculated to verify the discrimination and calibration capacities of these scoring systems in evaluating the prognosis for the elderly patients. Results Mean scores of the APACHE Ⅱ and SOFA were all significantly lower in the survival group than those in the non-survival group （P 〈 0. 01 ）. The SOFA scores declined gradually in the survival group and increased in the non-survival group during the first two weeks they stayed at ICU, P 〈0. 01. Analysis for the correlation between the APACHE Ⅱ and SOFA scores showed a coefficient of correlation r of 0. 551 and P-value less than 0. 01. The aROC was 0. 77 for the APACHE Ⅱ scores and 0. 73, 0. 90, 0. 95, 0. 98 and 0. 99 for the SOFA scores, respectively at the initial stage, 48 hours, 96 hours after admission, the delta and the maximum in predicting mortality. Lemeshow-Hosmer chi-square for fit of goodness was 7.22 with P 〉 0. 05 indicating good calibration capacity of the APACHE Ⅱ scores. Conclusions The APACHE Ⅱ scoring system and usingthe SOFA score continuously can predict the severity and prognosis for the elderly critical patients accurately, especially the maximum SOFA and delta SOFA scores. Combining both the APACHE Ⅱ and SOFA scores in evaluating the severity of illness for the elderly critical patients can improve their accuracy in prognostic evaluation.
出处
《中华全科医师杂志》
2007年第7期407-410,共4页
Chinese Journal of General Practitioners
