3种危重症评分系统对心脏大血管外科术后患者预后评估的分析

目的　分析比较在心脏大血管手术后应用急性生理学与慢性健康状况评分 (APACHE )、多器官功能障碍综合征 (MODS)评分以及序贯器官衰竭评估 (SOFA) 3种评分系统对患者预后评估的临床意义。方法　对 2 0 0 4年 2— 6月的 6 8例心脏大血管手术患者在心脏外科重症监护室治疗期间每日应用APACHE 、MODS和 SOFA评估其预后 ,并进行统计学相关分析。结果　术后 1～ 3d,APACHE 、MODS和 SOFA评分没有统计学差异 ,但均显著高于入室时各评分基础值 A0、M0和 S0水平 (P均 <0 .0 1) ;每日各评分值与基础值间的差值ΔA、ΔM和Δ S虽然逐渐降低 ,但没有统计学差异。 APACHE 评分与 MODS正相关 ,但相关性下降 (1d时 P<0 .0 1;3d时 P<0 .0 5 ) ;与 SOFA仅在 1d和 2 d呈正相关 (P均 <0 .0 1) ;MODS与 SOFA始终呈显著正相关 (P<0 .0 0 1)。心脏外科重症治疗监护病房停留时间与 A0和 Am ax正相关 (P<0 .0 5 ) ;与 M0、Mm ax以及 S0、Sm ax呈显著正相关 (P<0 .0 0 1)。结论　对于心脏大血管外科围手术期患者 ,A0可较准确地预测其预后 ;MODS和 SOFA对预后的评估能力优于 APACHE ;个体化 Smax和动态 Δ S可能是最合适的指标。

Analysis of prognosis assessment with acute physiology and chronic health evaluation Ⅲ,multiple organ dysfunction score and sequential organ failure assessment for the postoperative patients in cardiovascular surgery

OBJECTIVE: To analyze the clinical significance of the prognosis assessment with acute physiology and chronic health evaluation III (APACHEIII), multiple organ dysfunction score (MODS) and sequential organ failure assessment (SOFA) for postoperative patients in cardiovascular surgery. METHODS: Prognosis of 68 patients undergoing cardiovascular operation from February 2004 to June 2004 in our ward was assessed by APACHE III, MODS and SOFA. Then the scores were calculated and compared everyday while they stayed in Cardiac Surgery Intensive Care Unit (CSICU). RESULTS: The scores of three methods showed no significant difference from one another in the first three postoperative days, but were significantly higher than all the scores calculated just after the entrance to the CSICU (A0, M0, S0; all P<0.01). There were no differences in the changes of APACHE III, MODS and SOFA(DeltaA, DeltaM and DeltaS) in the first three postoperative days respectively, although they all showed a decreasing tendency. APACHE III scores were positively correlated with MODS although the correlation were diminishing (P<0.01 at first day but P<0.05 at third day), while they were positively correlated with SOFA only in the first two days (both P<0.01). The MODS was positively correlated with SOFA at various time points (P<0.001). The length of stay in CSICU was positive correlated with A0 and maximum of APACHEIII (Amax, P<0.05), and M0, maximum of MODS (Mmax) as well as S0, maximum of SOFA (Smax, P<0.001), respectively. CONCLUSION: For the patients who have undergone cardiovascular operation, A0 could assess the prognosis fairly precisely, but MODS and SOFA assessment seem to be better than APACHE III. Individual Smax and kinetic DeltaS might be the most suitable indexes for cardiovascular surgery.