ICU基本评分系统

ICU基本评分系统“It’smoreimportanttoknowwhatsortofpersonthisdiseasehas,thanwhatsortofdiseasethispersonhas.”

WilliamOsler1849-1919ICU评分的目的ICU评分系统可帮助我们？Case-mixadjustmentforevaluativeresearchAtoolforcomparativeaudit–SMR评估医护工作的效果

standardizedmortalityratio:>1.0or<1.0AmechanismtodecideresourceallocationAnaidfortheclinicalmanagementofpatients评分基础PhysiologicparameterAnatomicinjuryCombinedOrganfunctionTherapeuticInterventionICU评分的种类SpecificorgenericAnatomicalorphysiological

Anatomicalsystems–assessextentofinjury(eginjuryseverityscore)Physiologicalsystems–assessimpactofinjuryonfunction(egGCS)Measuringseveritybytreatment-TISSMeasuringseveritybypatientcharacteristicsandphysiologicalmeasurements-APACHE,SAPS,MPM评分系统的选择标准ProposeduseValidityofscoreReliabilityofscoreDiscriminationofscoringsystemCalibrationofscoringsystemSeverityIndexAPACHE(AcutePhysiologyandChronicHealthEvaluation)SAPS(SimplifiedAcutePhysiologyScore)MPM(MortalityPredictionModel)TISS(TherapeuticInterventionScoringSystem)MODS(MultipleOrganDysfunctionScore)TRISS(TraumaInjurySeverityScore)APACHE发展史KnausandColleaguesatGeorgeWashingtonUniversitydeveloped:Firstintroducedin1981.In1985,APACHEIImodelintroduced.In1991,APACHEIIImodelintroducedIn2006,APACHEIVmodelintroducedAPACHEIAPACHEI=APS（acutephysiologyscore

）+CPS（chronichealthpoints）APS=34physiologicalvariables（0~4scores）CPS=A~DTotalscores=0~Ato128~DAPACHEIIAPACHEII=APS+Age+CPSAPS=12variables(0~4scores,0~60)Age=0~6scoresCPS=2~5scoresTotalscores=0~71scoresPredicteddeathrateLogit=-3.517+(ApacheII)*0.146

PredictedDeathRate

=eLogit/(1+eLogit)APACHEIIIAPACHE=APS+Age+CPSAPS=0~252CPS=0~23Age=0~24Totalscores=0~299Predicteddeathrate(AIII)ismoreaccuracythanAIIAPACHEIV

Newvariables(mechanicalventilation,thrombolysis,theimpactof

sedationonGlasgowComaScore(GCS),andarescaledGCSandPaO2:FIO2)wereaddedAPACHEIIAPS（acutephysiologyscore

）GCSAgeCPS（chronichealthpoints）APACHEIIAPS（acutephysiologyscore

）APS-PulmonaryConditionRespiratoryratenon-ventilatedorventilatedOxygenationa.FiO2≧0.5recordA-aDO2b.FiO2＜0.5recordPaO2

ArterialpH(A-a)O2Gradient=(760-47)*FIO2-PaCO2-Pa02SerumCreatinine：

WithoutAcuteRenalFailureWithAcuteRenalFailure–DoubleSerumHCO3：

notpreferred,useifnoABGs

APS-RenalConditionAPS-GlasgowComaScoreGlasgowComaScoreUsedaspartofseveralICUscoringsystem,includingAPACHEⅡ,SAPSⅡandSOFA,asacontributionforthestatusofthecentralnervoussystem.Classifiedas:severe,withGCS≦8moderate,GCS9-12minor,GCS≧13GlasgowComaScoreNeurologicalscaleafterheadtraumaLimitedtobodytraumaandchildren,especiallybelowtheageof36monthsCorrelateswellwithoutcomefollowingseverebraininjuryOnedeterminesthebesteyeopeningresponse,thebestverbalresponse,andthebestmotorresponse.Scores=15–actualGCSAge年齡

≦4445-5455-6465-74≧75分數

02356CPS（chronichealthpoints）指住院前患者具有严重器官功能障碍或免疫功能受损病史评分标准：择期手术后患者（2分）非手术或急诊手术后患者（5分）因全身性感染或呼吸心跳骤停入ICU，纳入非手术组CPS评估项目CardiovascularRespiratoryLiverinsufficiencyRenalImmuno-depressionCPS-CardiovascularNYHAClassIVClassI日常活动无症状ClassII日常活动有症状ClassIII轻微活动就会有明显症状ClassIV休息时也出现症状CPS-Respiratory

慢性限制性、阻塞性或血管性疾病导致的严重活动受限：无法爬楼梯、处理家务

慢性低氧血症(hypoxia)

高碳酸血症(hypercapnia)

继发性红细胞增多症（polycythemia）

严重肺动脉高压(PAP>40mmHg)

高度依赖呼吸机CPS-Liverinsufficiency

-活检诊断肝硬化

-门静脉高压(portalhypertension)-门脉高压导致上消血病史

-肝功能衰竭/肝性脑病/肝昏迷病史CPS-RenalReceivingchronicdialysisCPS-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，AIDSAPACHEIIAIIPredicteddeathrate

Logit=-3.517+(ApacheII)*0.146

PredictedDeathRate=eLogit/(1+eLogit)50122104112023221Kpa=7.5