Bion J F, Aitchison T C, Edlin S A, Ledingham I M
Clinical Shock Study Group, Western Infirmary, Glasgow, Scotland.
Intensive Care Med. 1988;14(2):167-72. doi: 10.1007/BF00257472.
A physiological sickness scoring system (SS), based on the APACHE II score, has been used to assess outcome from critical illness in 128 patients admitted to a general intensive care unit. Physiological data were collected on each patient from admission until death or discharge from the unit, and survival was recorded as survival to home. The admission SS correctly classified 80.6% of survivors, and 70.4% of non-survivors. Predictive power did not improve with time using the daily SS. However, when the proportional change in SS over time was included in the analysis, predictive power improved; and at day 4, 87.1% of survivors and 75% of non-survivors were correctly classified. At intermediate levels of sickness severity (admission score of 13-18), a reduction in SS of 30% by day 4 reduced the risk of death by 32%; at higher levels (greater than 18) a similar reduction in SS was associated with a 47% reduction in death-risk. Failure to obtain a reduction in score by day 4 was associated with increased risk of death. Survivors consistently showed a greater fall in SS by day 4 than non-survivors. The APACHE score and its modifications provide an accurate, unitary measure of physiological disturbance. Correction of abnormal physiology, and the measurement of responsiveness to therapy are important components in the prediction of outcome from critical illness.
一种基于急性生理学及慢性健康状况评分系统II（APACHE II）的生理疾病评分系统（SS），已用于评估入住综合重症监护病房的128例患者的危重病预后。从患者入院直至死亡或出院，收集每位患者的生理数据，并将存活情况记录为存活至出院回家。入院时的SS正确分类了80.6%的存活者和70.4%的非存活者。使用每日SS，预测能力并未随时间提高。然而，当分析中纳入SS随时间的比例变化时，预测能力有所提高；在第4天，87.1%的存活者和75%的非存活者被正确分类。在疾病严重程度中等水平（入院评分为13 - 18）时，到第4天SS降低30%可使死亡风险降低32%；在较高水平（大于18）时，类似的SS降低与死亡风险降低47%相关。到第4天未能使评分降低与死亡风险增加相关。存活者在第4天的SS下降幅度始终大于非存活者。APACHE评分及其改良版提供了一种准确、统一的生理紊乱测量方法。纠正异常生理状况以及衡量对治疗的反应性是预测危重病预后的重要组成部分。
