APACHEⅡ评分联合乳酸清除率在呼吸衰竭患者病情和预后评估中的意义

摘要

Objective To evaluate the role of APACHEⅡscore combined with lactate clearance rate in the evaluation of severity and prognosis of patients with respiratory failure. Methods Fifty patients with respiratory fail-ure admitted to ICU of our hospital were divided into two groups:survival group and death group. APACHEⅡscore and blood gas analysis results of two groups of patients at the time points of entering the ICU after 0 h, 12 h, 24 h, 48 h and 72 h were retrospectively analyzed. Linear regression analysis and ROC analysis were carried out to evaluate these indicators' role on rating the prognosis of patients with respiratory failure. Results APACHEⅡscore, A-aO2 at different time points in the death group was signifiantly higher than thsoe in the survival group, and lactate clearance rate was significantly lower, all with P<0.05. PaO2/FiO2 values in the death group 24 h, 48 h and 72 h after entering in-to the ICU were significantly lower than those in the survival group (P<0.05). The area under the ROC curve (AUC) for APACHEⅡscore 24 h and 72 h after entering ICU were 0.92 and 0.96, and the area for lactate clearance rate 12 h, 24 h, 48 h and 72 h after entering ICU were 0.92, 0.92, 0.91 and 0.99, respectively. Conclusion APACHEⅡscore applied in combination with lactate clearance rate is of clinical significance for assessing the severity and prognosis of patients with respiratory failure.%目的：评价APACHEⅡ评分和乳酸清除率对呼吸衰竭患者病情程度和预后的评估作用。方法选取50例入住我院ICU呼吸衰竭患者分为存活组和死亡组，回顾性分析进入ICU后0 h、12 h、24 h、48 h和72 h各时间点两组患者的APACHEⅡ评分和血气分析指标并作组间比较；分别将APACHEⅡ评分、A-aO2值、PaO2/FiO2值与时间点作线性回归分析，运用ROC曲线分析检测各项观察指标对呼吸衰竭患者预后的评估作用。结果死亡组患者各时间点APACHEⅡ评分和A-aO2值均高于存活组患者，差异均有统计学意义(P<0.05)；死亡组患者各时间点乳酸清除率均低于存活组患者，差异均有统计学意义(P<0.05)；进入ICU 24 h、48 h和72 h死亡组患者PaO2/FiO2值均低于存活组患者，差异均有统计学意义(P<0.05)；APACHEⅡ评分ROC曲线下面积在24 h和48 h分别为0.92和0.96；各时间点乳酸清除率ROC曲线下面积分别为0.92、0.92、0.91、0.99。结论 APACHEⅡ评分联合乳酸清除率可以作为可靠的指标评估呼吸衰竭患者病情程度和预后的指标。