PACHEⅢ联合MPMⅡ对重度颅脑损伤患者的评估价值

目的探讨APACHEⅢ联合MPMⅡ对重度颅脑损伤患者病情严重程度评估及预测预后的价值。方法回顾性地对106例重度颅脑损伤患者在ICU24h内进行APACHEⅢ评分，入ICU时进行MPMⅡ0评估，预测PHM，比较存活组与死亡组之间的差异，比较APACHEⅢ评分不同计分段与实际病死率的关系，比较APACHEⅢ评分不同计分段的预测PHM与实际病死率的差异。结果存活组（33例）与死亡组（73例）APACHEⅢ、MPMⅡ0均有显著性差异（P〈0．01）。全组预测PHM为（68．275±18．982）％，与实际病死率68．87％非常接近。APACHEⅢ计分≤60、61—90、91—120、≥121四个分数段的MPMⅡ0比较，除91—120与≥121外，差异均有显著性（P〈0．05）。且预测的PHM与四个分数段的实际病死率接近度良好（P〉0．05）。结论APACHEⅢ联合MPMⅡ对重度颅脑损伤患者病情严重程度的评估具有很好的互补性，较高的准确性与精确度，APACHEⅢ评分越高，病情越重，预测的PHM越高，实际死亡率也越高。

The value of combining APACHEⅢ with MPMⅡ to assess the condition of patients with the severe brain injury

Objective To discuss the value of combining APACHE Ⅲ with MPM Ⅱ to assess the conditions of patients with the severe brain injury,and predict their recovery. Methods Review 106 cases of patients with the severe brain injury; used APACHE Ⅲ method to analyze their conditions during the first 24 hours when the patients were admitted into ICU;used MPM Ⅱ method to evaluate their illness upon the patients' admission into ICU ;and predicted PHM. Comparing the difference between the survival group and the death group,the relationship of the different scoring stages in APACHE Ⅲ analysis with that of the actual mortality rate, and the difference between the predicted PHM of different scoring stages in APACHE Ⅲ analysis and the actual mortality rate. Results There were significant differences in APACHEⅢ and MPMⅡ between the survival group(33 cases) and the death group (73 cases)(P<0.01 ). We predicted PHM was(68.275±18.982)% ; and this number was closed to the actual mortality rate, which was 68.87%. Among the different APACHEⅢ scoring stages, which were score ≤ 60, score at 61-90, score at 91-120, score ≥ 121 respectively, significant difference existed ( P<0.05 )among them,except the two stages,which were score at 91-120, score ≥ 121. PHM predicated was very closed to the real death rate(P>0.05). Conclusion APACHE Ⅲ method could complement MPM Ⅱ method to assess the conditions of patients with the severe brain injury. By jointing the two methods,we could more accurately and precisely evaluate patients' condition. The higher score in APACHE Ⅲ method was, the more severe was the illness ;the higher the value of PHM forecasted was,the higher was the actual mortality rate.