在ICU创伤患者的APACHE II评分 (APACHE/m) 和结果的每日改善
Pao-Jen Kuo1, Sheng-En Chou2, Hang-Tsung Liu3
1Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan.
Risk management and healthcare policy
|November 19, 2025
概括
较快的生理改善,以APACHE/m衡量,并没有改善重症监护室 (ICU) 创伤患者的生存率. 矛盾的是,APACHE II分数的快速下降与更糟糕的结果相关,突出了最初的严重程度作为一个关键预测因素.
科学领域:
- 临界护理医学 临界护理医学
- 创伤外科 手术 创伤外科
- 医疗保健服务研究 医疗服务研究
背景情况:
- 急性生理学和慢性健康评估II (APACHE II) 评分是标准的ICU严重性指标,但仅提供入院评估.
- 开发了一种新型指标,APACHE/m (APACHE II分数的平均每日下降),以评估生理改善率对患者结局的影响.
- 这项研究调查了ICU创伤患者更快的生理改善和更好的结果之间的相关性.
研究的目的:
- 为了确定是否更快的生理改善率,如APACHE/m所示,预测了成人创伤患者进入ICU的更好的结果.
- 为了比较高和低APACHE/m分数的创伤患者之间的住院死亡率和住院时间.
主要方法:
- 一项回顾性队列研究包括1784名成人创伤患者,他们从2016年至2023年被录取到一级创伤中心ICU,他们幸存于ICU退院.
- 在入院和出院时的APACHE II分数被用于计算APACHE/m (分数下降除以ICU停留时间).
- 倾向性得分匹配 (1:1) 用于控制初始损伤严重程度和并发症,在高和低APACHE/m组之间比较结果时.
主要成果:
- 在ICU出院后,医院死亡率为2.3%. 仅APACHE/m就显示出死亡率预测能力较差 (AUC=0.57).
- 在不匹配的队列中,高和低APACHE/m组之间的死亡率相似 (2.6%对2.0%,P=0.523).
- 在倾向性得分匹配后,高APACHE/m的患者比低APACHE/m的患者表现出更长的住院时间 (14 vs. 12天,P=0.005) 和明显更高的死亡率 (3.5% vs. 0%,P=0.022)
结论:
- 在APACHE II得分 (高APACHE/m) 的快速下降与ICU创伤患者的生存率的改善无关.
- 与预期相反,更快的生理改善与类似或更糟糕的晚期结果有关,可能是由于最初的疾病严重程度更大.
- 最初的伤害严重程度似乎是结果的更重要的预测因素,而不是ICU内的生理恢复率.
相关概念视频
01:14SBAR II: Application of SBAR
5.6K
SBAR is an effective communication tool used by healthcare professionals to communicate patient information accurately. SBAR stands for Situation, Background, Assessment, and Recommendation. For a better understanding, an example is given below.
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
5.6K
01:28Acute Coronary Syndrome IV: Interprofessional Care
203
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
203
01:20Acute Kidney Injury V: Interprofessional Care
284
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
284
01:21Acute Respiratory Failure-II
992
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
992
01:22Acute Kidney Injury I: Introduction
536
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
536
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
286
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
286