APACHEⅡ评分系统在大面积脑梗死患者中的应用价值
The application value of APACHEⅡ scoring system in patients with massive cerebral infarction

李涛,单南冰.APACHEⅡ评分系统在大面积脑梗死患者中的应用价值[J].内科急危重症杂志,2017,23(4):

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英文关键词:massive cerebral infarction acute physiology and chronic health evaluation systemⅡ prognosis

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作者	单位	E-mail
李涛	阜阳市第二人民医院	litaofyey@qq.com
单南冰	阜阳市第二人民医院	1653527867@qq.com

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中文摘要:

目的：分析急性生理与慢性健康状况评分系统Ⅱ（APACHEⅡ评分）对大面积脑梗死患者总体预后评估中的应用价值。方法：选取2015年9月-2017年1月间我院重症监护室（ICU）收治大面积脑梗死患者57例作为研究对象，收集入院后24h内APACHEⅡ评分结果资料。比较37例生存患者和20例死亡患者APACHEⅡ评分差异，采用ROC曲线的方法评估APACHEⅡ评分预测死亡的灵敏度、特异度和准确性，划分生存和死亡的最佳APACHEⅡ评分临界值，Lemeshow-Hosmer拟合优度检验APACHEⅡ评分的可靠程度。结果：生存组APACHEⅡ均分11.78±7.75，低于死亡组的16.80±7.69，差异显著，具有统计学意义（t=2.336，P=0.023）；ROC曲线结果显示，APACHEⅡ评分预测死亡的曲线下面积（AUC）为0.713[95%CI（0.579，0.846）]，达到统计学中“较为准确”标准；APACHEⅡ评分升高的最佳临界值为15分，此时的灵敏度为73.5%，特异度为70.1%，准确度为82.4%；Lemeshow-Hosmer拟合优度检验c2值=2.873，P=0.814。结论：APACHEⅡ评分可以作为大面积脑梗死患者病情预测的可靠标准，用于指导临床救治工作。

英文摘要:

Objective:To analyze the application value of acute physiology and chronic health evaluation systemⅡ(APACHEⅡscore) in the evaluation of overall prognosis in patients with massive cerebral infarction.Methods:57 case of patients with massive cerebral infarction in intensive care unit (ICU) during September 2015 - January 2017 were recruited in this study,collect the data of APACHEⅡ score within 24h after admission.Compare the difference of APACHEⅡ score between 37 cases of survival patients and 20 cases of deaths,ROC curve method was conducted to evaluate the?specificity,sensitivity and accuracy of APACHEⅡscore,confirm the threshold of APACHEⅡscore in distinguishing survival and death,Lemeshow - Hosmer goodness-of-fit test was carried out to detect the reliability of APACHEⅡscore.Results:The average APACHEⅡ score of survival group was 11.78±7.75,lower than that of death group(16.80±7.69),with statistically significant difference (t=2.336，P=0.023);ROC curve showed that the area under the curve (AUC) of APACHEⅡscore predicting death was 0.713,95%CI(0.579，0.846),reach the statistical standards of "comparatively accurate".The threshold of APACHEⅡscore was 15,corresponding Sensitivity, specificity and accuracy were 73.5%,70.1% and82.4% respectively;The c2value of Lemeshow - Hosmer goodness-of-fit test was 2.873, P=0.814.Conclusion: APACHEⅡ score can be treated as a reliable standard in predicting the prognosis of massive cerebral infarction patiens,and guideing the clinical treatment.