CAJ | 학술논문

目的：评价急性生理学及慢性健康状况评分Ⅱ（ APACHEⅡ）、急性生理学及慢性健康状况评分Ⅲ（APACHEⅢ）、改良爱丁堡-斯堪的纳维亚评分（MESSS）、美国国立卫生研究院卒中量表（NIHSS）、日常生活活动能力（ ADL）评分、格拉斯哥昏迷（ GCS）评分和伴发疾病、既往史评分对急性脑梗死患者近期死亡的预测价值。方法于入院24 h内对399例急性脑梗死患者分别进行APACHEⅡ、APACHEⅢ、MESSS、NIHSS、ADL、GCS和伴发疾病、既往史评分，以1个月为界根据存活状况将其分为生存组和死亡组。用聚类分析方法对八种量表进行聚类分析，通过描绘受试者工作特征曲线（ ROC曲线）分析其对急性脑梗死患者预后的真实性。结果与生存组比较，死亡组APACHEⅡ、APACHEⅢ、MESSS、NIHSS及伴发疾病评分显著升高，GCS及ADL评分显著降低（均P＜0.01）。两组间既往史评分差异无统计学意义（ P＞0.05）。聚类分析结果显示， APACHEⅡ和APACHEⅢ归为一类， MESSS 和NIHSS归为一类， ADL、GCS和伴发疾病评分各自形成一类。APACHEⅡ、APACHEⅢ、MESSS 和NIHSS的ROC曲线下的面积两两比较差异无统计学意义（均Z＜1．96）。APACHEⅡ预测急性脑梗死的最佳界值为12分，APACHEⅢ为29分，MESSS为25分，NIHSS为10分。结论APACHEⅡ、APACHEⅢ、MESSS、NIHSS评分对急性脑梗死患者的近期死亡有较好的预测价值。
목적：평개급성생이학급만성건강상황평분Ⅱ（ APACHEⅡ）、급성생이학급만성건강상황평분Ⅲ（APACHEⅢ）、개량애정보-사감적납유아평분（MESSS）、미국국립위생연구원졸중량표（NIHSS）、일상생활활동능력（ ADL）평분、격랍사가혼미（ GCS）평분화반발질병、기왕사평분대급성뇌경사환자근기사망적예측개치。방법우입원24 h내대399례급성뇌경사환자분별진행APACHEⅡ、APACHEⅢ、MESSS、NIHSS、ADL、GCS화반발질병、기왕사평분，이1개월위계근거존활상황장기분위생존조화사망조。용취류분석방법대팔충량표진행취류분석，통과묘회수시자공작특정곡선（ ROC곡선）분석기대급성뇌경사환자예후적진실성。결과여생존조비교，사망조APACHEⅡ、APACHEⅢ、MESSS、NIHSS급반발질병평분현저승고，GCS급ADL평분현저강저（균P＜0.01）。량조간기왕사평분차이무통계학의의（ P＞0.05）。취류분석결과현시， APACHEⅡ화APACHEⅢ귀위일류， MESSS 화NIHSS귀위일류， ADL、GCS화반발질병평분각자형성일류。APACHEⅡ、APACHEⅢ、MESSS 화NIHSS적ROC곡선하적면적량량비교차이무통계학의의（균Z＜1．96）。APACHEⅡ예측급성뇌경사적최가계치위12분，APACHEⅢ위29분，MESSS위25분，NIHSS위10분。결론APACHEⅡ、APACHEⅢ、MESSS、NIHSS평분대급성뇌경사환자적근기사망유교호적예측개치。
Objective To evaluate the predictive value of acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) , acute physiology and chronic health evaluation Ⅲ( APACHEⅢ) , modified Edinburgh-Scandinavia stroke scale(MESSS), national institutes of health stroke scale(NIHSS), activity of daily living(ADL), Glasgow coma scale(GCS), complication scale and past history scale in recent death for patients with acute ischemic stroke . Methods Three hundred and thirty-nine patients with acute ischemic stroke were tested with APACHEⅡ, APACHEⅢ, MESSS, NIHSS, ADL, GCS, complication scale and past history scale within 24 hours after admission.Patients were divided into survivor group and death group according to the status of survival or death after 1 month of morbidity.Using cluster analysis methods to analysis the eight rating scales , and evaluated the reality of them by making receiver operating characteristic ( ROC) curves.Results Compared with survivor group , the scores of APACHEⅡ, APACHEⅢ, NIHSS, MESSS and complication scale in death group were significantly higher , and the scores of ADL and GCS were significantly lower ( all P<0.01 ) .There was no significant difference of past history scale between the two groups (P>0.05).The cluster analysis showed the MESSS and NIHSS were in the same class , APACHEⅡand APACHEⅢwere in the same class, and ADL, GCS, complication scale were belonged to one class respectively .Multiple comparison showed no significant difference of area under curve in ROC between APACHE Ⅱ, APACHEⅢ, MESSS and NIHSS(all Z<1.96).The optimal cut-off point of acute ischemic stroke of APACHEⅡwas at 12, while APACHEⅢwas at 29, MESSS was at 25, and NIHSS was at 10.Conclusion APACHEⅡ, APACHEⅢ, MESSS and NIHSS have good predictive value in recent death of patients with acute ischemic stroke .