APACHEⅡ評分在急診危重症患者病情評估中的價值

Predictive value of APACE II score for the condition in severe patients of emergency department

王小鷗(WANG Xiao Ou)；蘇玲敏(SU Ling Ming)；何澄幫(HE Cheng Bang)；陳意(CHENG Yi)

APACHEⅡ評分 ； 危重症患者 ； 病情評估 ； APACHE II score ； Critically ill patients ； Prognosis ant mortality

鏡湖醫學

21卷1期（2021 / 06 / 01）

30 - 32

繁體中文;英文

目的：探討APACHEⅡ評分在急診危重症患者病情評估中的價值。方法：回顧性收集本院2018年4月～2018年9月急診搶救室患者資料進行APACHEⅡ評分，按是否建議入住ICU分為ICU1組和非ICU1組；剔除急診綠色通道（急性冠脈綜合征和急性腦卒中）後，再分為ICU2組和非ICU2組。按30天後是否死亡分為死亡組和非死亡組。分別比較三組患者APACHEⅡ評分區別，繪製ROC曲線並計算曲線下面積（AUC），計算建議入住ICU預測評分界值以及評估死亡預測評分界值。結果：ICU1組APACHEⅡ評分高於非ICU1組，差異有統計學意義（P <0.05），ICU2組APACHEⅡ評分高於非ICU2組，差異有統計學意義（P <0.05），建議入住ICU預測評分界值為13.5分。死亡組APACHEⅡ評分顯著高於非死亡組，差異有統計學意義（P <0.05），評估死亡的預測評分界值為16.5分。結論：APACHEⅡ評分能有效判斷急診危重症患者病情嚴重程度及預後，對指導急診搶救室患者去向及死亡預後有預測價值。

Objective: To investigate the value of APACHEII score in predicting severe patients' condition in emergency department. Methods: Patients were retrospectively collected in the resuscitation room of Emergency Department in Kiang Wu Hospital from April to September 2018. APACHE II scores were calculated at the time of admission. Patients who were suggested or not suggested for ICU admission were divided into ICU1 and non-ICU1 groups., They were further divided into ICU2 and non-ICU2 groups after excluding cases of the emergency green channel (acute coronary syndrome and acute stroke). Moreover, patients were also divided into two groups based on their prognosis after 30 days: survival group and death group. APACHE II scores between the three different ways of grouping were compared. The receiver operating characteristics (ROC) curve was plotted and the area under the curve (AUC) calculated. The cut-off values of APACHE II scores were determined for ICU admission and mortalityprediction. Results: The average APACHEII score of ICU1group was significantly higher than that of non-ICU1 group (P<0.05). The average APACHE II score in the ICU2 group was also significantly higher than that in the non-ICU2 group, the difference was statistically significant (P<0.05). The cut-off value for APACHE II in patients admitted with ICU was 13.5. That of the death group was higher than that of survival group with statistically significant difference (P<0.05). For prediction of mortality, the APACHE II cut-off score was 16.5. Conclusion: APACHE II scores can effectively judge the severity and prognosis of critically ill patients in the emergency department. These predictive values can guide the attending clinicians to decide the prognosis of patients in the emergency department and predict mortality.