APACHE-Ⅱ和Ⅳ评分系统在心血管危重症中应用的比较

目的:探讨APACHE-Ⅱ和APACHE-Ⅳ在判断心血管疾病危重情况及预测预后能力的强弱。方法:随机入选1 005例心血管重症患者,比较每个分值段和每种疾病APACHE-Ⅱ和APACHE-Ⅳ的预测病死率和实际病死率,以及实际死亡情况和分值之间的关系。结果:ROC曲线下的面积APACHE-Ⅱ和APAVHE-Ⅳ分别是0.631,0.764。实际病死率随两种评分系统的分值而增加。APACHEⅡ,仅10分组,20分组和肺源性心脏病组,预测病死率在实际病死率95%可信区间内。APACHEⅣ,除肺心病组预测病死率不在实际病死率95%可信区间内,其余分组两者差异无统计学意义。结论:APACHE-Ⅳ对于心血管疾病病死率预测的价值优于APACHE-Ⅱ。

APACHE-Ⅳ scoring system is used in critically ill patients with cardiovascular disease

Objective：compare the ability of APACHE-Ⅱ and APACHE-Ⅳ in assessing the severity of cardiovascular disease and predicting prognosis of the critically ill patients in the ICU. Methods： 1005 patients who got severe cardiovascular disease were observed randomly. Evaluate the consistency of predicted mortality and real mortality,the correlation between APACHE score and real mortality. Results： The area of under receiver operating characteristic of APAVHE-Ⅱ and APACHE-Ⅳ is 0. 631,0. 764,respectively. Real mortality increased along with the APACHE score. APAVHE-Ⅱ,only in group 10 score,group 20 score and group pulmonary heart disease,predicted mortality is in the 95% confidence interval of real mortality. APACHE-Ⅳ,Only in group pulmonary heart disease,predicted mortality is not in the 95% confidence interval of real mortality.APAVHE-Ⅱ and APACHE-Ⅳ score of non-survivors is higher than survivors（ P〈0.05）. Conclusion： APACHE-Ⅳ for the predictive value of cardiovascular mortality is better than APACHE-Ⅱ.