急性生理学与慢性健康状况评分系统（APACHE III）在重症监护病房孕产妇入院评估中的应用价值。

Utility of Acute Physiology, Age, and Chronic Health Evaluation (APACHE III) score in maternal admissions to the intensive care unit.

作者信息

Stevens Tobey A, Carroll Mary A, Promecene Pamela A, Seibel Marilyn, Monga Manju

机构信息

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Medical School Houston, TX, USA.

出版信息

Am J Obstet Gynecol. 2006 May;194(5):e13-5. doi: 10.1016/j.ajog.2006.01.073.

DOI:10.1016/j.ajog.2006.01.073

PMID:16647889

Abstract

OBJECTIVE

A mean Acute Physiology, Age, and Chronic Health Evaluation (APACHE III) score of > 50 is associated with increased intensive care unit mortality rate in nonpregnant cardiac and trauma patients. The objective was to determine the usefulness of the APACHE III score in maternal admissions to an intensive care unit in a tertiary care center in an urban multicultural city.

STUDY DESIGN

This was a retrospective review of all maternal admissions (> 20 weeks of gestation or after delivery) to an intensive care unit between January 2002 and May 2004. Demographics, obstetric and medical history, and 20 physiologic variables that comprise the APACHE III were recorded. The minimum APACHE III score (lowest risk of death) is 0; maximum is 299. The association between APACHE III score and maternal death was assessed with Mann Whitney U test. Significance was assumed at a probability value of < .05.

RESULTS

Fifty-eight subjects met the study criteria. Thirty percent of these women were admitted antepartum (27 +/- 1.0 weeks of gestation); 31% of the women were admitted on the day of delivery; and 29% of the women were admitted after delivery. Mean maternal age was 27 +/- 6.7 years. Acute conditions that resulted in transfer to the intensive care unit included preeclampsia (24%), cardiorespiratory disease (21%), hemorrhage (16%), infection (12%), trauma (7%), and thromboembolism (3%). Fifty-five percent of the women had no previous underlying obstetric complications, and 98% of the women had no underlying chronic health condition. Fifty-eight percent of the women received care in a medical intensive care unit; 28% of the women received care in a surgical intensive care unit; 10% of the women received care in a cardiac intensive care unit, and 3% of the women received care in a neurologic intensive care unit. The mean intensive care unit stay was 3.7 +/- 4.6 days, and the mean hospital stay was 9.0 +/- 7 days. Three patients died; the rest of the patients went home in good condition. The median APACHE III score was 34 (range, 14-102) and was not correlated with maternal death.

CONCLUSION

The APACHE III is not associated with risk of intensive care unit-related maternal death.

摘要

目的

在非妊娠心脏和创伤患者中，急性生理学与慢性健康状况评分系统（APACHE III）平均得分>50与重症监护病房死亡率增加相关。本研究目的是确定APACHE III评分在城市多元文化环境下的三级医疗中心收治的重症监护病房产妇中的应用价值。

研究设计

这是一项对2002年1月至2004年5月期间所有入住重症监护病房的产妇（妊娠>20周或分娩后）的回顾性研究。记录了人口统计学、产科和病史以及构成APACHE III的20项生理变量。APACHE III评分的最小值（死亡风险最低）为0；最大值为299。采用曼-惠特尼U检验评估APACHE III评分与产妇死亡之间的关联。当概率值<0.05时认为具有统计学意义。

结果

58名受试者符合研究标准。这些女性中30%在产前入院（妊娠27±1.0周）；31%的女性在分娩当天入院；29%的女性在产后入院。产妇平均年龄为27±6.7岁。导致转入重症监护病房的急性情况包括先兆子痫（24%）、心肺疾病（21%）、出血（16%）、感染（12%）、创伤（7%）和血栓栓塞（3%）。55%的女性既往无产科并发症，98%的女性无慢性健康问题。58%的女性在医疗重症监护病房接受治疗；28%的女性在外科重症监护病房接受治疗；10%的女性在心脏重症监护病房接受治疗，3%的女性在神经重症监护病房接受治疗。重症监护病房平均住院时间为3.7±4.6天，平均住院时间为9.0±7天。3例患者死亡；其余患者情况良好出院。APACHE III评分中位数为34（范围14 - 102），与产妇死亡无相关性。