CAJ | 학술논문

目的：探讨急性生理与慢性健康评分( APACHE Ⅱ评分)对急性冠脉综合征患者病情的评价及预后的预测价值,同时探讨结合TIMI危险评分对预后预测价值是否有影响。方法对198例CCU急性冠脉综合征患者进行APACHEⅡ评分并计算病死危险度、TIMI危险评分及其两者之和的总得分,应用接受者操作特征曲线下面积( AUROCC)比较3种评分的分辨能力。结果 APACHE Ⅱ评分存活组为(9.42±3.38)分,与病死组(14.77±3.27)分比较,差异有统计学意义(t=-8.018,P<0.01)；TIMI危险评分存活组为(3.48±0.96)分,与病死组(5.57±0.68)分比较,差异有统计学意义(t=-11.383,P<0.01)。在 ST 段抬高型心肌梗死组中 APACHE Ⅱ评分为(10.33±3.86)分,预测病死率11.61%(13/112)与实际病死率18.75%(21/112)差异有统计学意义(χ2=15.998,P<0.01)；在非ST段抬高型心肌梗死组中,APACHEⅡ评分为(10.10±4.14)分,预测病死率11.63%(10/86)与实际病死率10.47%(9/86)差异无统计学意义(χ2=79.330,P>0.05)；总体急性冠脉综合征APACHE Ⅱ评分为(10.23±3.86)分,预测病死率11.62%(23/198)与实际病死率15.15%(30/198)差异有统计学意义(χ2=29.892,P<0.01)。3种评分的ROC曲线下面积比较,TIMI危险评分具有最大的ROC曲线下面积,其预测存活与死亡的分辨度最好。结论 APACHE Ⅱ评分对于心血管病重症患者尤其是在急性冠脉综合征患者不能很好地预测病死率,而且结合TIMI危险评分后也未发现此种新评估方法相对TIMI危险评分的明显优势,TIMI危险评分为急性冠脉综合征患者的一种快捷、方便、有效的评估手段。
목적：탐토급성생리여만성건강평분( APACHE Ⅱ평분)대급성관맥종합정환자병정적평개급예후적예측개치,동시탐토결합TIMI위험평분대예후예측개치시부유영향。방법대198례CCU급성관맥종합정환자진행APACHEⅡ평분병계산병사위험도、TIMI위험평분급기량자지화적총득분,응용접수자조작특정곡선하면적( AUROCC)비교3충평분적분변능력。결과 APACHE Ⅱ평분존활조위(9.42±3.38)분,여병사조(14.77±3.27)분비교,차이유통계학의의(t=-8.018,P<0.01)；TIMI위험평분존활조위(3.48±0.96)분,여병사조(5.57±0.68)분비교,차이유통계학의의(t=-11.383,P<0.01)。재 ST 단태고형심기경사조중 APACHE Ⅱ평분위(10.33±3.86)분,예측병사솔11.61%(13/112)여실제병사솔18.75%(21/112)차이유통계학의의(χ2=15.998,P<0.01)；재비ST단태고형심기경사조중,APACHEⅡ평분위(10.10±4.14)분,예측병사솔11.63%(10/86)여실제병사솔10.47%(9/86)차이무통계학의의(χ2=79.330,P>0.05)；총체급성관맥종합정APACHE Ⅱ평분위(10.23±3.86)분,예측병사솔11.62%(23/198)여실제병사솔15.15%(30/198)차이유통계학의의(χ2=29.892,P<0.01)。3충평분적ROC곡선하면적비교,TIMI위험평분구유최대적ROC곡선하면적,기예측존활여사망적분변도최호。결론 APACHE Ⅱ평분대우심혈관병중증환자우기시재급성관맥종합정환자불능흔호지예측병사솔,이차결합TIMI위험평분후야미발현차충신평고방법상대TIMI위험평분적명현우세,TIMI위험평분위급성관맥종합정환자적일충쾌첩、방편、유효적평고수단。
Objective To investigate the predictive value of acute physiology and chronic health score ( APCHE Ⅱ) scoring system on the patients with acute coronary syndrome ( ACS) , and to demonstrate whether the predictive value combined with TIMI risk score impact on prognosis. Methods We calculated APACHEⅡ, TIMI risk score and total score of these two for 198 patients with acute coronary syndrome ( ACS) in CCU, and compared the discriminative power of the three scores by the area under the receiver operating characteristic curve ( AUROCC ) . Results The APACHEⅡscores of survival group ( 9. 42 ± 3. 38 ) and death group (14. 77 ± 3. 27) were statistically significant (t= -8. 018,P<0. 01). The survival groups of TIMI risk score was (3.48±0.96), while the score of death group (5.57 ±0.68), (t = -11.383,P<0.01). For ST segment elevation myocardial infarction group, the score of APACHEⅡwas ( 10. 33 ± 3. 86 ) and predicted mortality 11. 61% (13/112) and actually mortality 18. 75% (21/112) (χ2 =15. 998,P <0. 01); in non-ST segment elevation myocardial infarction group, the score of APACHEⅡwas ( 10. 10 ± 4. 14 ) and predicted mortality 11. 63% (10/86) and actually mortality 10. 47% (9/86) (χ2 =79. 330,P>0. 05);for the total ACS, the score of APACHEⅡwas (10. 23 ± 3. 86) and predicted mortality 11. 62% (23/198) and actually mortality 15. 15%(30/198) (χ2 =29. 892,P<0. 01). The ROC curve area of 3 score methods had been compared and found out TIMI had the biggest ROC curve area and the best predicted livability and mortality. Conclusions APACHEⅡscore can not predict mortality satisfactorily in patients with ACS well, and the method of APACHEⅡcombined with TIMI risk score is not better than TIMI risk score showed in the study. The TIMI risk score is a quick, convenient and effective method to evaluate patients with ACS.