APACHEⅡ评分在外科ICU中的应用

目的 :应用急性生理学与慢性健康状况评分 (APACHE )评价外科 ICU(SICU)中患者的病情危重程度并判断其预后 ,以证明其在 SICU中应用的有效性。方法 :连续观察入 SICU资料完整患者 15 0例 ,分别计算各自 APACHE 评分及预计病死率 ,并进行验证。结果 :15 0例患者的 APACHE 评分范围 0～ 31分 ,平均 (11.0 2± 7.4 3)分 ;生存 132例评分 (9.5 5± 6 .18)分 ,死亡 18例评分 (2 1.78± 7.0 7)分 ,差异显著 (P<0 .0 1)。APACHE 评分与实际病死率间呈显著正相关 (r=0 .72 ,P<0 .0 1)。 APACHE 评分与预计病死率间呈显著正相关 (r=0 .78,P<0 .0 1)。APACHE 分值以 5分阶增加 ,实际及预计病死率亦增加 ,且 APACHE 评分大于 2 0分时预计与实际病死率均明显升高 ,提示预后较差。在 APACHE 评分低分值段阳性率偏低 ,高分值段敏感性又降低。结论 :1APACHE 评分系统可应用于 SICU作为评估患者危重程度及预后的重要指标。 2通过分析预计与实际病死率间的差异 ,可客观地评价 SICU的医疗及监护质量。3APACHE 评分可为合理利用SICU资源及开展学术交流提供参考。 4 APACHE 评分在预测 SICU患者预后时有效性是有限的     

APACHEⅡ评分在急诊ICU的临床应用分析

目的 分析急性生理学与慢性健康状况评分Ⅱ系统(APACHE Ⅱ)在急诊重症监护病房(ICU)中应用及其对治疗和预后评估是否具有指导意义.方法 收集2007～2008年收住自治区人民医院急救中心ICU 的928例患者临床资料.分析收入急诊ICU后24 h内的 APACHEⅡ评分结果.患者按转入急诊ICU后28 d是否死亡分为死亡组和存活组,比较两组APACHEⅡ评分.结果 死亡组患者的APACHEⅡ评分明显高于非死亡组,两组比较差异有统计学意义(P＜0.05).结论 APACHE Ⅱ评分可以客观、准确地评估病人的预后,对危重病患者预后评估具有指导意义.     

APACHEⅡ评分在ICU铜绿假单胞菌下呼吸道感染患者中的应用

目的 :应用急性生理学及慢性健康状况评分 (acute physiology and chronic health evaluation ,APACHE )系统评估重症监护病房 (intensive care unit,ICU )中铜绿假单胞菌 (PA)下呼吸道感染患者的疾病的危重程度、感染治疗效果、入住 ICU时间和预后。方法 :对比观察入住 ICU并且合并下呼吸道 PA感染的12 2例患者 ,按 Knaus法进行 APACHE 评分 ,并进行临床对比。结果 :全部患者共死亡 2 9例 ,APACHE 分值为 (18.78± 7.13)分 ;未死亡者 93例 ,APACHE 分值为 (11.70± 5 .79)分 ,两者差异显著 (t=5 .4 3,P<0 .0 1)。合并感染者较非合并感染者 APACHE 评分高〔(14 .76± 6 .89)分比 (10 .0 8± 6 .14 )分 ,P<0 .0 1〕,预后差 (2 7.91%比 13.89% ,P<0 .0 1) ;重症肺炎患者较非重症肺炎患者 APACHE 评分高〔(15 .5 7± 6 .97)分比(11.81± 6 .0 3)分 ,P<0 .0 1〕,预后差 (39.2 2 %比 12 .6 8% ,P<0 .0 1)。随 APACHE 分值的升高 ,患者的重症肺炎例数增多 ,感染治疗效果差 ,病死率升高 ;预计病死率和实际病死率均与 APACHE 分值呈显著正相关 ,APACHE 分值以 5分阶增加时 ,实际和预计病死率亦增加 ,预测死亡概率的敏感性和阳性率分别为10 0 .0 0 %和 86 .72 %。结论 :在 PA下呼吸道感染的 ICU患者中 ,APACHE      

APACHEⅡ评分在急诊ICU的临床应用分析临床研究

目的分析急性生理学与慢性健康状况评分Ⅱ系统(APACHEⅡ)在急诊重症监护病房(ICU)中应用及其对治疗和预后评估是否具有指导意义。方法收集2007～2008年收住自治区人民医院急救中心ICU的928例患者临床资料。分析收入急诊ICU后24 h内的APACHEⅡ评分结果。患者按转入急诊ICU后28 d是否死亡分为死亡组和存活组,比较两组APACHEⅡ评分。结果死亡组患者的APACHEⅡ评分明显高于非死亡组,两组比较差异有统计学意义(P<0.05)。结论 APACHEⅡ评分可以客观、准确地评估病人的预后,对危重病患者预后评估具有指导意义。     

APACHEⅢ评分在ICU中的应用评价

目的 :应用急性生理学和慢性健康状况评分 (APACHE )评价重症监护病房 (ICU)患者的病情和预后 ,并与 APACHE 进行比较。方法 :对我院 2 0 0 0年 7月— 2 0 0 2年 1月 ICU中 87例危重患者的资料 (其中存活组 6 6例 ,死亡组 2 1例 )用《危重疾病评分系统》中 APACHE 和 APACHE 进行评分 ,并将 APACHE 中死亡概率 (Ps)与实际病死率进行对比。结果 :死亡组 APACHE 和 APACHE 分值均明显高于存活组(P均 <0 .0 1) ;APACHE 和 APACHE 分值与病死率呈正相关 ,APACHE >6 0分者病死率明显增加 ,Ps≤ 0 .5者实际病死率明显高于 Ps>0 .5者 (P<0 .0 1)。结论 :APACHE 分值配合 APACHE 的 Ps可较好地评价危重疾病的严重程度 ,预测预后     

APACHEⅡ评分在急诊危重病人风险管理中的应用

[目的]探讨利用急性生理学及慢性健康状况评分Ⅱ（APACHEⅡ）评分系统指导急诊科预见性地进行护理风险评估效果。[方法]将急诊危重病人138例随机分为对照和实验组。对照组根据主观判断病人的病情进行常规护理;实验组对所有病人进行评分,进行护理干预,并指导护理人员加强风险防范的环节;比较两组在病人的满意度、抢救率以及护理人员工作满意度的差异。[结果]实验组病人的满意度、抢救成功率、护理人员工作满意度与对照组比较,差异有统计学意义（P〈0.05）。[结论]应用APACHEⅡ评分进行急诊危重病人评估,能使护理人员简便快捷的识别护理风险,以更好地加强护理风险防范,提高护理质量。     

APACHEⅡ评分在急诊危重病人风险管理中的应用

[目的]探讨利用急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)评分系统指导急诊科预见性地进行护理风险评估效果.[方法]将急诊危重病人138例随机分为对照和实验组.对照组根据主观判断病人的病情进行常规护理;实验组对所有病人进行评分,进行护理干预,并指导护理人员加强风险防范的环节;比较两组在病人的满意度、抢救率以及护理人员工作满意度的差异.[结果]实验组病人的满意度、抢救成功率、护理人员工作满意度与对照组比较,差异有统计学意义(P＜0.05).[结论]应用APACHEⅡ评分进行急诊危重病人评估,能使护理人员简便快捷的识别护理风险,以更好地加强护理风险防范,提高护理质量.     

APACHEⅢ评分在急诊ICU中的应用评价

急性生理学及慢性健康状况评分系统 (APACHE)是目前临床上重症监护病房 (ICU)应用最广泛而且最具权威的危重病病情评价系统。本研究拟采用APACHE 评分系统和多器官功能障碍综合征 (MODS)病情分期诊断及严重程度评分对我院急诊重症监护病房(EICU)收治的危重症患者进行分析 ,探讨其在 EICU的应用价值。1　病例与方法1.1　病例 :2 0 0 1年 12月— 2 0 0 2年 7月入住 EICU资料全患者 ,其中 6 7例患者中 ,男 4 9例 ,女 18例 ;年龄 15～ 90岁 ,平均 5 2 .5 7岁 ;重型颅脑外伤 6例 ,复合伤 2例 ,心血管疾病 11例 ,呼吸系疾病15例 ,神…     

APACHEⅡ评分系统在基层医院ICU中的应用

ＡＰＡＣＨＥⅡ评分系统在国外已广泛用于对重危患者病情严重程度的分析和预后转归的评估,并指导临床救治工作。本文对１９９６年９月～１９９７年１０月我院麻醉科ＩＣＵ收治的手术后重危患者用ＡＰＡＣＨＥⅡ评分系统进行分析,探讨基层医院ＩＣＵ应用ＡＰＡＣＨＥⅡ评分系统的适用性。１　资料与方法研究对象均为手术后收入麻醉科ＩＣＵ的重危患者,入住时间超过２４小时。采集患者进入ＩＣＵ后第一个２４小时的急性生理学极端数据的评分、年龄评分和慢性健康状态评分,三项评分之和即为ＡＰＡＣＨＥⅡ评分。计算死亡危险度,公式为：ｌ…     

APACHEⅡ评分在百草枯中毒中的运用及回归模型建立

目的应用急性生理学及慢性健康状况评分(APACHEⅡ)评估百草枯农药中毒患者的病情危重程度并判断其预后,以证明其应用的有效性。方法连续观察入EICU百草枯农药中毒资料完整患者66例,分别计算各自APACHEⅡ评分,并进行验证,建立回归模型。结果66例患者APACHEⅡ评分2~35分,平均(11.60±9.24)分。38例生存者APACHEⅡ评分(5.58±3.02)分,28例死亡者APACHEⅡ评分(19.79±8.52)分,两者差异有统计学意义(t=-6.74,P<0.01)。进行Logis-tic回归分析后得到死亡风险模型。结论APACHEⅡ评分系统可应用于百草枯农药中毒患者危重程度及预后的评估。     

急性生理学与慢性健康状况评分系统在ICU中的应用

危重疾病严重程度的把握对于医护策略、药物疗效观察、疾病预后的判断以及ICU人力物力的运筹都至关重要.近年急性生理学及慢性健康状况评分系统也受到我国许多学者和临床工作者的重视.规范制定标准化、具有高精确度和特异度的评分标准为危重症室医护人员所探求,现就其研究进展做一综述.     

Acute physiology and chronic health evaluation (APACHE II) scoring in a cardiothoracic intensive care unit

OBJECTIVE: To evaluate the predictive value of the Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system in cardiothoracic surgical patients. DESIGN: Prospective survey with follow-up to hospital discharge. SETTING: A cardiothoracic surgical ICU in a tertiary referral center. PATIENTS: Eight hundred sixty-nine consecutive patients admitted to the ICU were entered into this study. Data on 12 patients were incomplete. Forty-three patients had nonsurgical diagnoses. Three patients had noncardiothoracic operations. These exclusions left 811 patients for analysis, and all results pertain to these 811 cardiothoracic surgical patients. INTERVENTIONS: Demographic and physiologic data relevant to the APACHE II score were collected on all patients and entered into a microcomputer database for analysis. MEASUREMENTS AND MAIN RESULTS: The following procedures were performed: 65% of patients had coronary artery bypass grafts; 23% had heart valve surgery; 5% had thoracic surgical procedures; and the remainder had a variety of cardiothoracic operations. The mean duration of ICU care was 2.3 days and the mean age was 57 yrs. The mean APACHE II score was 9.5 and the overall predicted risk of dying was 4.59%, with an actual ICU mortality rate of 4.56%. The relationship between the APACHE II score and mortality rate was linear and significant (p less than .001). Patients with an APACHE II score of less than 10 had a mortality rate of 0.93%. Only a score of greater than 30 was uniformly associated with death, and then only in one patient. A chronic disease history, emergency surgery, and a longer ICU stay were significant markers for mortality. CONCLUSIONS: There was a good relationship between the APACHE II score and mortality rate. Low APACHE II scores accurately predicted survival but only very high scores accurately predicted death.     

Novel methods to treat and prevent human papillomavirus infection

The human papillomavirus (HPV), a ubiquitous sexually transmitted virus, is the causative agent for cervical dysplasia and carcinoma worldwide. Current treatment methods primarily utilize ablative and excisional procedures to remove dysplastic, HPV-infected cervical tissue. However, these procedures require intensive cytopathological surveillance and carry inherent risks of bleeding, infection and possible future pregnancy complications. Development of an effective vaccine against HPV would dramatically reduce the need for costly cytological and histological surveillance. HPV represents an ideal candidate for vaccine development, and current research efforts in the realm of prophylactic and therapeutic vaccine design show great promise. A host of various vaccine techniques are currently being developed and tested and, if effective, will have a significant impact on the incidence of cervical dysplasia and carcinoma.     

Implementing best practice strategies to prevent infection in the ICU

Critically ill patients are at high risk for infection because of many factors. Quality and regulatory groups have published guidelines regarding infection prevention in the ICU. A multifaceted, multiprofessional team approach is necessary to develop and implement strategies to prevent infection in the critically ill patient. Bundles of intervention along with daily rounds an assessment are essential program components. Ongoing surveillance and re- education and reinforcement are also part of a strong infection prevention program.     

Acute physiology and chronic health evaluation (APACHE II) and Glasgow coma scores as predictors of outcome from intensive care after cardiac arrest

OBJECTIVES: a) To examine the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Glasgow Coma Scores as predictors of the outcome of patients following resuscitation from cardiac arrest; b) to study the impact of the components of APACHE II on the prediction. DESIGN: A nationwide study in Finland with prospectively collected data on all patients admitted to intensive care after cardiac arrest during a 14-month period. Two thirds of the cardiac arrest patients included in the study were randomly selected to derive predictive models, and the remaining one third constituted the validation sample. SETTING: A total of 25 medical and surgical ICUs in Finland (13 in tertiary referral centers). PATIENTS: Six-hundred nineteen consecutive cardiac arrest patients. Fifteen patients less than 16 yrs were excluded. MAIN OUTCOME MEASURES: Variables included in the APACHE II or Glasgow Coma Scores were collected at the time of ICU admission and then three times after admission, at 24-hr intervals. ICU- and hospital-mortality rates and a 6-month mortality rate after ICU admission were studied. RESULTS: Of 604 study patients, 370 (61.3%) patients died in the hospital. The most accurate prediction of hospital outcome was based on data collected after the first day of ICU care, not on the admission values. Twenty-one (21.9%) of 96 patients with a low APACHE II score (less than or equal to 9) died compared with 66 (84.6%) of 78 patients with a high APACHE II score (greater than or equal to 25) (p less than .001). Of 160 patients with a normal Glasgow Coma Score (14 to 15), 45 (28.1%) died, whereas there were 114 (81.4%) nonsurvivors among 140 patients with a low Glasgow Coma Score of 3 (p less than .001). The performance of predictive models, including age, the Chronic Health Evaluation, and either the Acute Physiology Score (Acute Physiology Score model) or the Glasgow Coma Score (Glasgow Coma Score model) were compared with the prediction according to the APACHE II in the validation sample. When using 80% probability of death as a decision rule, the Acute Physiology Score model determined 35 of 153 patients to have high risk of death, 29 of whom died (the positive predictive value being 82.9%). The Glasgow Coma Score model predicted 34 patients to die, 26 of whom died (positive predictive value 76.5%), and the APACHE II score predicted seven deaths, five of whom actually died (positive predictive value 71.4%). CONCLUSIONS: The APACHE II scoring system cannot be recommended as a prognostic tool to support clinical judgement in cardiac arrest patients, but by modifying it, a more accurate prediction of poor outcome could be achieved. The Glasgow Coma Score explained to a great extent the predictive power of the APACHE II.     

急性生理学与慢性健康状况Ⅱ评分在连续性血液净化治疗多器官功能障碍综合征中的应用

连续性血液净化(continuous blood purification。CBP)已成为治疗各种原因引起的多器官功能障碍综合征(multiple organ dysfunction syndrome，MODS)患者的常见方法。但因费用昂贵，限制了其临床使用。本研究目的在于明确急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分用于指导CBP治疗MODS患者选择时机的价值。