摘要
目的探讨APACHEⅣ评分系统在脑卒中预后及危险因素分析中的临床应用。方法选取2012年3月—2013年9月在我院治疗的脑卒中患者54例,入院24 h后对患者进行APACHEⅣ评分。记录患者各项评分得分,并分析死亡与存活患者各项得分情况;分析患者APACHEⅣ得分与预测死亡危险系数与实际病死率之间的关系,并利用ROC曲线下面积衡量APACHEⅣ评分预测脑卒中患者病死率的效果。结果患者的总体评分分值在8~42分之间,患者得分的差异项主要有血肌酐水平、年龄、心率以及血压等,其中存活组的平均得分（13.52±6.68）分,明显高于死亡组的（26.42±6.48）,差异具有统计学意义（P〈0.05）。当患者APACHEⅣ得分〉30分时,其预测死亡的准确率最高,且随着得分和预测死亡危险系数增加,患者实际病死率也在升高,预测病死率与实际病死率呈正相关（r=0.93,P〈0.01）。ROC曲线下面积为0.79,说明其预测脑卒中患者病死率效果良好。结论脑卒中的危险因素主要有血肌酐水平、年龄、心率以及血压等,APACHEⅣ评分系统对脑卒中患者预后具有较好的预测作用,值得临床推广应用。
Objective Toinvestigatethe clinic function application of APACHE Ⅳ scoring system in the analysis of prognosis and risk factors of stroke. Methods select54 patients who had cerebral apoplexy treatment from March1 th,2012to September 1th,2013 in our hospital. 24 hours after admission,testing the patients with APACHE Ⅳ score. Record various scores and analyze the score of the dead and survived patients. Analysis the relationship between predicted mortality risk coefficient of APACHE Ⅳ and the actual case fatality rate. Using the area under the ROC curve to measure the accuracy of APACHE Ⅳ score in predicting mortality in patients with cerebral apoplexy. Results The patient＇s overall score is 8 to42 points,score difference items mainly include serum creatinine level,age,heart rate and blood pressure,etc. The average score of survival patients is（13.52 ±6.68）,significantly higher than that of the death patients（26.42±6.48）. The difference is statistically significant（P〈0.05）. When APACHE Ⅳ scores of patients is more than 30 points,APACHE Ⅳ gains the highest prediction accuracy of death. With the increase of score and predicted death risk,the death rate increased,so predictedmortalityof APACHEⅣwaspositivelycorrelatedwiththeactualmortality（r=0.93,P〈0.01）.Areaunderthe ROC curve was 0.79,indicating APACHE Ⅳ has good effect in predicting the mortality of cerebral apoplexy patients. Conclusion The serum creatinine levels,age,heart rate and blood pressure, etc. are the major risk factors of stroke. APACHE Ⅳ scoring system shows good predicting effect in predicting prognosis in patients with cerebral apoplexy,which means APACHE Ⅳ system is worthy of clinical popularization and application.
出处
《基层医学论坛》
2015年第10期1299-1301,共3页
The Medical Forum
