中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
11期
660-663
,共4页
吉春玲%周厚荣%彭春红%杨秀林%张谦
吉春玲%週厚榮%彭春紅%楊秀林%張謙
길춘령%주후영%팽춘홍%양수림%장겸
急性心肌梗死%全球急性冠状动脉事件注册评分%急性生理学与慢性健康状况评分系统Ⅱ评分%急诊内科评分%死亡风险
急性心肌梗死%全毬急性冠狀動脈事件註冊評分%急性生理學與慢性健康狀況評分繫統Ⅱ評分%急診內科評分%死亡風險
급성심기경사%전구급성관상동맥사건주책평분%급성생이학여만성건강상황평분계통Ⅱ평분%급진내과평분%사망풍험
Acute myocardial infarction%Global registry of acute coronary events%Acute physiology and chronic health evaluation Ⅱ risk score%Rapid emergency medicine risk score%Risk of death
目的 研究全球急性冠状动脉事件注册评分(GRACE)、急性生理学与慢性健康状况评分系统Ⅱ评分(APACHEⅡ)及急诊内科评分(REMS)3种评分方法对急性心肌梗死(AMI)患者近期死亡风险的预测价值.方法 采用回顾性研究方法,收集2012年10月至2013年3月贵州省人民医院急诊科及心内科重症监护病房(CCU)收治的390例AMI患者的临床资料,记录24 h内GRACE、APACHEⅡ及REMS评分的最差值,以及发病后30 d内因心血管疾病死亡的病例数,比较3种评分系统对AMI发病后30 d内死亡风险的预测价值.结果 发病30 d内因心血管疾病共死亡54例患者,实际病死率为13.8％.死亡患者GRACE、APACHEⅡ及REMS评分均明显高于存活患者[GRACE(分):206.09±24.67比150.17±25.72,t=-4.349,P=0.000;APACHEⅡ(分):15.81±7.60比7.50±2.83,t=-4.182,P=0.000；REMS(分):7.11±2.70比5.38±2.59,t=-2.345,P=0.020].GRACE、APACHEⅡ及REMS评分预测AMI患者发病30 d内心血管疾病死亡风险的受试者工作特征曲线(ROC)下面积(AUC)分别为0.862[95％可信区间(95％CI)0.76～ 0.95,P=0.000]、0.825(95％CI 0.71～0.93,P=0.002)和0.615(95％CI 0.46～0.77,P=0.192),敏感度分别为92.32％、76.91％、69.26％,特异度分别为66.23％、77.84％、54.02％.结论 GRACE、APACHEⅡ评分对AMI患者短期内死亡风险有预测价值,GRACE评分预测更准确；REMS对AMI的近期死亡风险无预测价值.
目的 研究全毬急性冠狀動脈事件註冊評分(GRACE)、急性生理學與慢性健康狀況評分繫統Ⅱ評分(APACHEⅡ)及急診內科評分(REMS)3種評分方法對急性心肌梗死(AMI)患者近期死亡風險的預測價值.方法 採用迴顧性研究方法,收集2012年10月至2013年3月貴州省人民醫院急診科及心內科重癥鑑護病房(CCU)收治的390例AMI患者的臨床資料,記錄24 h內GRACE、APACHEⅡ及REMS評分的最差值,以及髮病後30 d內因心血管疾病死亡的病例數,比較3種評分繫統對AMI髮病後30 d內死亡風險的預測價值.結果 髮病30 d內因心血管疾病共死亡54例患者,實際病死率為13.8％.死亡患者GRACE、APACHEⅡ及REMS評分均明顯高于存活患者[GRACE(分):206.09±24.67比150.17±25.72,t=-4.349,P=0.000;APACHEⅡ(分):15.81±7.60比7.50±2.83,t=-4.182,P=0.000；REMS(分):7.11±2.70比5.38±2.59,t=-2.345,P=0.020].GRACE、APACHEⅡ及REMS評分預測AMI患者髮病30 d內心血管疾病死亡風險的受試者工作特徵麯線(ROC)下麵積(AUC)分彆為0.862[95％可信區間(95％CI)0.76～ 0.95,P=0.000]、0.825(95％CI 0.71～0.93,P=0.002)和0.615(95％CI 0.46～0.77,P=0.192),敏感度分彆為92.32％、76.91％、69.26％,特異度分彆為66.23％、77.84％、54.02％.結論 GRACE、APACHEⅡ評分對AMI患者短期內死亡風險有預測價值,GRACE評分預測更準確；REMS對AMI的近期死亡風險無預測價值.
목적 연구전구급성관상동맥사건주책평분(GRACE)、급성생이학여만성건강상황평분계통Ⅱ평분(APACHEⅡ)급급진내과평분(REMS)3충평분방법대급성심기경사(AMI)환자근기사망풍험적예측개치.방법 채용회고성연구방법,수집2012년10월지2013년3월귀주성인민의원급진과급심내과중증감호병방(CCU)수치적390례AMI환자적림상자료,기록24 h내GRACE、APACHEⅡ급REMS평분적최차치,이급발병후30 d내인심혈관질병사망적병례수,비교3충평분계통대AMI발병후30 d내사망풍험적예측개치.결과 발병30 d내인심혈관질병공사망54례환자,실제병사솔위13.8％.사망환자GRACE、APACHEⅡ급REMS평분균명현고우존활환자[GRACE(분):206.09±24.67비150.17±25.72,t=-4.349,P=0.000;APACHEⅡ(분):15.81±7.60비7.50±2.83,t=-4.182,P=0.000；REMS(분):7.11±2.70비5.38±2.59,t=-2.345,P=0.020].GRACE、APACHEⅡ급REMS평분예측AMI환자발병30 d내심혈관질병사망풍험적수시자공작특정곡선(ROC)하면적(AUC)분별위0.862[95％가신구간(95％CI)0.76～ 0.95,P=0.000]、0.825(95％CI 0.71～0.93,P=0.002)화0.615(95％CI 0.46～0.77,P=0.192),민감도분별위92.32％、76.91％、69.26％,특이도분별위66.23％、77.84％、54.02％.결론 GRACE、APACHEⅡ평분대AMI환자단기내사망풍험유예측개치,GRACE평분예측경준학；REMS대AMI적근기사망풍험무예측개치.
Objective To evaluate and compare the predictive value of short-term risk of death of global registry of acute coronary events (GRACE) risk scores,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)scores and rapid emergency medicine score (REMS) in patients with acute myocardial infarction (AMI).Methods A retrospective review of clinical data of 390 patients with AMI admitted from October 2012 to March 2013 in emergency department and cardiology care unit (CCU) in Guizhou People's Hospital were performed.The lowest scores within 24 hours of GRACE risk score,APACHE Ⅱ risk score,and REMS risk score,respectively,for each patient were recorded.Mortality rate within 30 days after onset was calculated.Prediction of the mortality rate of AMI within 30 days as made in three scoring systems was compared.Results A total of 54 patients died from cardiovascular disease within 30 days.GRACE risk scores,APACHE Ⅱ scores,and REMS risk scores were higher in non-survivors as compared with that of survivors (GRACE:206.09 ± 24.67 vs.150.17 ± 25.72,t=-4.349,P=0.000; APACHE Ⅱ:15.81 ± 7.60 vs.7.50 ±2.83,t=--4.182,P=0.000; REMS:7.11 ±2.70 vs.5.38 ±2.59,t=-2.345,P=0.020).Area under the receiver operator characteristic curve (ROC curve) for GRACE risk scores,APACHE Ⅱ risk scores and REMS in patients with AMI died from cardiac vascular disease in 30 days were 0.862 [95％ confidence interval (95％ CI)0.76-0.95,P=0.000],0.825 (95％CI 0.71-0.93,P=0.002) and 0.615 (95％CI 0.46-0.77,P=0.192),sensitivity of three kinds of scoring system was 92.32％,76.91％,69.26％,respectively,with specificity of 66.23％,77.84％,54.02％ respectively.Conclusion GRACE and APACHE Ⅱ scores for patients with AMI risk of short-term death showed more accurate in predicting early than GRACE scores,and REMS for AMI risk of short-term death did not have predictive value.
