CAJ | 학술논문

目的探讨急性生理学和慢性健康状况评估(APACHE)Ⅱ对危重神经疾病严重程度评估的可靠性,以及预测预后的准确性.方法对2005、2006年收入神经内科重症监护病房的404例患者在0、24、48和72 h时间点进行连续APACHE Ⅱ评分.通过统计学分析,确定APACHE Ⅱ评分与预测预后最为相关的时间点,确定预测预后较为准确的界值.结果 APACHE Ⅱ分值变化与预后结局取向分明,即分值愈高病死率越高,分值愈低存活率愈高;APACHEⅡ预测预后的受试者工作特征(ROC)曲线下面积为0.866(95% CI 0.824～0.907,P=0.000),预测最佳界值是17分,敏感性76.6%,特异性78.7%;Logistic回归模型显示,APACHE Ⅱ分值与预后关系最为密切的时间点是72 h(x2=137.345,P=0.000,总判断率85%);APACHE Ⅱ的14个参数中5个与预后相关,相关系数由高到低依次为Glasgow昏迷评分、心室率、血肌酐、体温和白细胞计数.结论 APACHE Ⅱ评分可很好地反映危重神经疾病患者病情严重程度,并能准确和可靠地预测预后.
목적 탐토급성생이학화만성건강상황평고(APACHE)Ⅱ대위중신경질병엄중정도평고적가고성,이급예측예후적준학성.방법 대2005、2006년수입신경내과중증감호병방적404례환자재0、24、48화72 h시간점진행련속APACHE Ⅱ평분.통과통계학분석,학정APACHE Ⅱ평분여예측예후최위상관적시간점,학정예측예후교위준학적계치.결과 APACHE Ⅱ분치변화여예후결국취향분명,즉분치유고병사솔월고,분치유저존활솔유고;APACHEⅡ예측예후적수시자공작특정(ROC)곡선하면적위0.866(95% CI 0.824～0.907,P=0.000),예측최가계치시17분,민감성76.6%,특이성78.7%;Logistic회귀모형현시,APACHE Ⅱ분치여예후관계최위밀절적시간점시72 h(x2=137.345,P=0.000,총판단솔85%);APACHE Ⅱ적14개삼수중5개여예후상관,상관계수유고도저의차위Glasgow혼미평분、심실솔、혈기항、체온화백세포계수.결론 APACHE Ⅱ평분가흔호지반영위중신경질병환자병정엄중정도,병능준학화가고지예측예후.
Objective To explore the reliability of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)to evaluate the severity of the neurologic diseases and its accuracy to predict the outcome of patients with these diseases.Metllods Four hundred and four consecutive patients with severe neurologic diseases between 2005 and 2006 were enrolled to obtain the APACHE Ⅱ scores at 0.24,48,72 h after admission to neurointensive care unit.Results The APACHE Ⅱ scores were positively associated with the outcome of the patients with severe neurologic diseases.The higher score corresponded with the higher mortality rate.The areas under the receiver operating characteristic curves of APACHE Ⅱ to predict the outcome was 0.866(95% CI 0.824 to 0.907.P=0.000).The optimal cutoff of APACHE Ⅱ scores to predict the outcome was 17 scores with the sensitivity of 76.7%and the specificity of 78.7%.The predictive chance that was mostly associated with the outcome was 72 h after admission in logistic regression model (x2=137.345,P=0.000,correct class%=85%).The factors that were the most statistically associated with the outcome in the 14 parameters of APACHE Ⅱ were GCS score,heart rate,serum creatinine,body temperature and WBC count.Conelusion APACHE Ⅱ favorably reflects the severity of the neurologic diseases and reliably and accurately predicts the prognosis of the patients.