重症病患疾病严重度评估课件

重症病患疾病严重度评估重症病患疾病嚴重度評估 重症病患疾病严重度评估目的預測死亡率及存活機率評估治療成果評估醫療資源利用的適當與否重症病患疾病严重度评估APACHE(AcutePhysiologyandChronicHeathEvaluation)NYHA(NewYorkHeartAssociation)classificationofheartfailureCCS(CanadianCardiovascularSociety)classificationofanginapectorisKillip’sclassificationofacutemyocardialinfarctionGCS(GlasgowComaScale)TISS(TherapeuticInterventionScoring)重症病患疾病严重度评估APACHEsystemAPACHE:1981,prototypeAPACHEⅡ:1985APACHEⅢ:1991

—developedbyICUResearchunit,GeorgeWashingtonUniversityMedicalcenter重症病患疾病严重度评估APACHEⅡ疾病嚴重度分類系統重症病患疾病严重度评估APACHEⅡAcutePhysiologyandChronicHealthEvaluation:scorecalculationAPACHEⅡScore=A+B+CA:acutephysiologyscorepointsB:agepoints

C:chronichealthpoints重症病患疾病严重度评估AcutePhysiologyScore(APS)Serumcreatinine:doublethepointsforARFOxygenationpoints:1.usePaO2directlywhenFiO20.52.calaculateAlveolar-arterialO2gradient(P[A-a]O2)whenFiO20.5

P[A-a]O2=[(700FiO2)-(Pa(O21.25)]-PaO2TheAPSisdeterminedfromthemostworstphysiologicvalueduringtheinitial24hrsafterICUadmission重症病患疾病严重度评估ChronicHealthpointsIfthepatienthasahistoryofsevereorgansysteminsufficiencyorisimmunocompromized1.non-operativeoremergencypostoperativepatients---------------------------------------5points2.forelectivepostoperativepatients--2pointIfthepatientdosenothaveseverechronichealthproblem------------------------------------------0point

定義：嚴重的器官系統疾病或免疫不全必須是在住院前已存在的慢性狀況以及符合下列標準。肝臟疾病：切片証實的肝硬化，被証實的門脈高壓（portalhypertension），曾發生因門脈高壓引起的上消化道出血，或曾發生肝衰竭／肝性腦病變／肝昏迷心臟疾病：NewYorkHeartAssociation(NYHA)ClassIV－休息時即有不適的症狀表現。呼吸系統疾病：因慢性限制性、阻塞性或血管性肺病導致的嚴重活動限制，即無法爬樓梯或做家事，或已証實的慢性低氧血症，高二氧化碳血症，次發性紅血球過多症，嚴重肺動脈高壓(大於40mmHg)或依賴呼吸器。腎臟疾病：接受慢性透析治療。免疫不全：病人接受造成免疫不全的治療，如：免疫抑制治療，化療，放射線治療，長期或最近高劑量類固醇治療。或病人患有造成免疫不全之疾病，如白血病，淋巴癌，AIDS等。結算：A急性生理狀態計分

B年齡計分

C慢性健康計分

APACHEⅡScore＝A＋B＋C

電腦畫面操作點選住院中患者作業選擇單位選擇病患進入操作畫面重症病患疾病严重度评估於<INPN37SB>畫面點選氧分壓『註』顯示之畫面重症病患疾病严