ICU基本评分系统课件

1、ICU基本评分系统“Its more important to know what sort of person this disease has, than what sort of disease this person has.”William Osler 1849-1919ICU评分的目的ICU评分系统可帮助我们？Case-mix adjustment for evaluative researchA tool for comparative audit SMR 评估医护工作的效果 standardized mortality ratio:1.0 or 40 mmHg) 高度依赖呼吸机

2、CPS- RenalReceiving chronic dialysisCPS- Immuno-depression 接受抑制抗感染能力的治疗：免疫抑制药、放化疗、长期或近期是用大剂量类固醇 免疫性疾病：白血病，淋巴瘤，AIDSAPACHE II50122104112023221Kpa=7.5 mmHgAPACHEII局限性群体敏感度好，个体预测准确率较低联合应用其他评价系统，提高预测准确性采样时间点选择？是否有最佳时间点？对PHM（pridict hospital mortality)的预测值偏高APS未考虑血管活性药物、呼吸机、非甾体类药物对各项参数影响老年患者计分比重偏高营养状态未列入计

3、分考虑对创伤患者考虑不充分SAPS (Simplified Acute Physiology Score)发展历史In 1984, Le Gall reduced former 34-variable APACHE score to 14 parameters,SAPS I In 1994,SAPS II(SAPS II score + PHM)In 2008,SAPS IIISAPS II构成：0163 scoresPhysiological variable:12 variable (026 scores/v),include GCSAge(0712151618score)Type of

4、admission(内科0、择期6、急诊8）3 chronic disease(AIDS18,Hematologic malignancy10,Meta-static cancer9)PHMSAPS II Data Data are collected during the first 24 hours after ICU admissionAgeUse the patients age in years at last birthdayHeart rateUse the worst value in 24 hours, either low or high rate; if it varie

5、d from cardiac arrest (11pts) to extreme tachycardia (7pts), assign 11points.SBPUse the same method as for hearth rate : eg, if it varied from 60 mmHg to 205 mmHg, assign 13 Points.Body temperatureUse the highest temperature in C or FPaO2/FiO2 ratioIf ventilated or CPAP, use the lowest value of the

6、ratio.SAPS II DataUrinary outputif the patient is in the intensive care unit for less than 24 hours, make the calculation for 24 hours.Serum urea or BUNUse the highest value in mmol/ or g/L for serum urea, in mg/dL for the serum urea nitrogen.WBC countUse the worst (high or low) WBC count.Serum pota

7、ssium levelUse the worst (high or low) value.Serum Sodium levelUse the worst (high or low) value.Serum bicarbonate levelUse the lowest value.BilirubinUse the highest value in micromol/L or mg/dLGlasgow coma scoreUse the lowest value. If the patient is sedated, record the estimated Glasgow coma score

8、 before sedation.SAPS II Predicted death rateLogit = -7.7631+0.0737*(SAPS II)+0.9971*ln(SAPS II)+1)Predicted Death Rate =e(Logit)/(1+e(Logit)SAPS24小時為緊急與否分界點；一週以上視為medicalAIDS,Hematologic malignancy,Meta-static cancer以未被sedation之前的GCS為基準沒有呼吸器之病患則以0分記Patients excluded :Coronary care, cardiac surgery, burn patients, age 15 years SAPS Very Simple and quick. (一个病人5min)Predict mortality without diagnosis. Application to individual patient is far difficult.SAPS