改良产科危重症评分在危重孕产妇病情评估中的意义

目的评价改良产科危重症评分系统在危重孕产妇病情评估中的意义。方法收集2004年1月至2010年12月转入福建医科大学附属第一医院ICU161例产科危重症临床病例。应用新建立的产科危重症病情评估系统对患者进行病情严重程度量化评分。比较死亡组与存活组之间各评分分值的差异。将APACHEⅡ评分系统和改良产科危重患者评分系统对危重症患者的诊断率做ROC曲线,找出截断值。分析患者评分分值与患者各器官功能障碍及预后的关系。结果改良产科危重症评分中存活组评分为8.33±5.74,死亡组为17.93±5.00,死亡组的评分明显高于存活组,差异有统计学意义(P<0.05)。随分值增加,病死率增加。改良产科危重症评分ROC曲线下面积(0.914)大于APACHEⅡ评分ROC曲线下面积(0.859)。随着评分的升高,母亲的器官功能障碍的阳性率增加,且与器官功能障碍发生数目增多呈显著正相相关关系(Kendall相关系数b=0.651,spearman相关系数b=0.784,均为P=0.000)。结论改良产科危重症评分比APACHEⅡ评分对危重孕产妇预后的预测性优越,评分分值越高,病情越重。改良产科危重症评分分值升高,母亲器官功能障碍发生的阳性率增加。

Modify severity of illness scoring systems to improve outcome prediction for critically ill obstetric patients.

Objective To evaluate the significance of modify severity of illness scoring systems in prediction for critically ill obstetric patients.Methods A retrospective medical record review was conducted involving 161 cases critically ill obstetric patients,who were admitted to the ICUs of The First Affiliated Hospital of Fujian Medical University between January 2004 and December 2010.To improve the APACHE Ⅱsystem according to the physiological and pathological characteristics during pregnancy.The scores depending on the the improved evaluation system were calculated.To compare the score differences between the survivors and non-survivors groups.Do the ROC curve of APACHEⅡsystem and the modified scoring system to find the cut-off point.The relationship between the score and the maternal outcomes were analyzed.Results A signlficant difference was found between survivors and non-survivors groups on the score of patients scored by the improved evaluation system for the critically ill obstetric patients respectively(P<0.05).The score of the survivors was 8.33±5.74,whereas the non-survivors was 17.93±5.00.The c-index for APACHE Ⅱ(0.859) was smaller than for the improved evaluation system in critically ill obstetric patients(0.914).With the score increased,the rate of the maternal organ dysfunction is increasing.and they are significantly positively correlated.Conclusion The improved evaluation system is better than APACHE Ⅱ system in predicting the prognosis in obstetric.With The higher the scores,the more severe the disease.