APACHEⅡ及MODS评分与肿瘤术后患者预后的相关性研究
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摘要
目的:探究APACHEⅡ评分结合多器官功能不全(MODS)评分系统对食管癌术后患者死亡预后的预测价值。方法:收集预试验期和2014年7月-2015年12月于本院进行食管癌开胸切除手术的80例患者的临床资料,按术后住院期间是否死亡分为死亡组和存活组;两组患者均于食管癌开胸手术术后入住ICU,进行MODS评分,且于入住后第1、3、5天分别进行APACHEⅡ评分;运用多变量COX比例风险模型分析MODS评分分值对死亡预后的预测价值,并且分析肿瘤术后MODS的发生与APACHEⅡ评分及MODS评分的相关性。结果:食管癌术后患者APACHEⅡ评分高低与患者预后存在相关性,APACHEⅡ评分分值越高,肿瘤术后患者的病情越重;并且,随着MODS评分增加,患者病死率增加;但是,APACHEⅡ评分预测病死率的准确性受MODS的影响较大,使得低分区预测值显著高于实际值,高峰期预测值显著低于实际值;多因素COX比例风险模型分析提示食管癌术后患者的预后指数为:PI=1.679×并发MODS+0.854×APACHEⅡ评分+1.079×MODS评分。结论:应用APACHEⅡ及MODS评分综合评估系统对肿瘤手术后患者的预后评估,可以使肿瘤手术后患者的预后评估更加具有可靠性和准确性。
Objective:To explore the prognostic value of APACHE Ⅱ scoring system combined with MODS scoring system in the prognosis of esophageal cancer patients after operation.Method:Clinical data of 80 patients who underwent preoperative trial from July 2014 to December 2015 for esophagectomy of thoracotomy in our hospital,according to postoperative death during hospitalization they were divided into death group and survival group.Patients of two groups were in thoracic esophageal cancer after surgery in ICU,MODS score on the first,third,fifth day APACHE score were given.Using multivariate COX proportional hazard model analyzed the value of MODS score in predicting the prognosis of death,the correlation of MODS and APACHE score and MODS score after tumor resection were analyzed.Result:The postoperative esophageal cancer patients APACHEⅡ score correlated with prognosis,APACHEⅡ score was higher,postoperative tumor patients with more serious illness.With the increase of MODS score,mortality increased.However,the accuracy of APACHEⅡ score in predicting mortality was seriously affected by MODS,the low partition prediction value was significantly higher than the actual value and predictive value of the peak was significantly lower than the actual value.COX multivariate analysis suggested that postoperative esophageal cancer prognosis index was PI=1.679×MODS+0.854×APACHEⅡ score+1.079×MODS score.Conclusion:The application of APACHE Ⅱ and MODS scoring system to evaluate the prognosis of patients after tumor operation can make the prognosis evaluation more reliable and accurate.
Objective:To explore the prognostic value of APACHE Ⅱ scoring system combined with MODS scoring system in the prognosis of esophageal cancer patients after operation.Method:Clinical data of 80 patients who underwent preoperative trial from July 2014 to December 2015 for esophagectomy of thoracotomy in our hospital,according to postoperative death during hospitalization they were divided into death group and survival group.Patients of two groups were in thoracic esophageal cancer after surgery in ICU,MODS score on the first,third,fifth day APACHE score were given.Using multivariate COX proportional hazard model analyzed the value of MODS score in predicting the prognosis of death,the correlation of MODS and APACHE score and MODS score after tumor resection were analyzed.Result:The postoperative esophageal cancer patients APACHEⅡ score correlated with prognosis,APACHEⅡ score was higher,postoperative tumor patients with more serious illness.With the increase of MODS score,mortality increased.However,the accuracy of APACHEⅡ score in predicting mortality was seriously affected by MODS,the low partition prediction value was significantly higher than the actual value and predictive value of the peak was significantly lower than the actual value.COX multivariate analysis suggested that postoperative esophageal cancer prognosis index was PI=1.679×MODS+0.854×APACHEⅡ score+1.079×MODS score.Conclusion:The application of APACHE Ⅱ and MODS scoring system to evaluate the prognosis of patients after tumor operation can make the prognosis evaluation more reliable and accurate.
引文
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[10]李晓如,李志军,王东强,等.APACHEⅡAPACHEⅢ评分及PSI评分评估老年重症肺炎预后的对比研究[J].中国急救医学,2015,35(11):1013-1016.
[11]李慧珍,张海英,赵艳伶,等.APACHEⅡ评分引入MODS评分系统对ICU危重症患者预后的预测价值[J].河北医学,2017,23(4):568-572.
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[14]任艺,邵旦兵,刘红梅,等.MEWS评分SCS评分和APACHEⅡ评分在评估急诊危重患者预后中的作用[J].中国急救医学,2013,33(8):711-714.
[15]孟新科,杨径,吴华雄,等.MEWS与APACHEⅡ评分在急诊潜在危重病患者病情评价和预后预测中的对比研究[J].实用临床医药杂志,2005,9(8):1-4.
[16]周洪,綦俊,张奇,等.心肌型脂肪酸结合蛋白联合APACHEⅡ评分对急性肺栓塞病情严重程度及预后的评估价值[J].中华胸心血管外科杂志,2017,33(4):204-207.
[17]王长远,曹涛,汤辉,等.NEWS评分MEWS评分和APACHEⅡ评分对急诊内科抢救室患者的评估价值[J].中国急救医学,2017,37(2):123-126.
[18]肖光明,贾卫东,何凯茵,等.应用Cox比例风险模型分析抗病毒治疗对慢性乙型重型肝炎预后的影响[J].实用肝脏病杂志,2009,12(3):190-194,206.
[19]李博志,胡怀强,程明,等.3种评分量表对热射病预后评估的比较[J].医学研究生学报,2016,29(5):518-521.
[20]林金锋,杨志洲,邵旦兵,等.MODS评分与应激性溃疡的相关性研究[J].中华急诊医学杂志,2014,23(8):847-851.
[2]Klevebro F,Ekman S,Nilsson M.Current trends in multimodality treatment of esophageal and gastroesophageal junction cancerReview article[J].Surg Oncol,2017,26(3):290-295.
[3]Varghese Y E,Kalaiselvan M S,Renuka M K,et al.Comparison of acute physiology and chronic health evaluationⅡ(APACHEⅡ)and acute physiology and chronic health evaluationⅣ(APACHEⅣ)severity of illness scoring systems,in a multidisciplinary ICU[J].J Anaesthesiol Clin Pharmacol,2017,33(2):248-253.
[4]Huang J,Xuan D,Li X,et al.The value of APACHEⅡin predicting mortality after paraquat poisoning in Chinese and Korean population:A systematic review and meta-analysis[J].Medicine(Baltimore),2017,96(30):e6838.
[5]Liu X W,Ma T,Li L L,et al.Predictive values of urine paraquat concentration,dose of poison,arterial blood lactate and APACHEⅡscore in the prognosis of patients with acute paraquat poisoning[J].Exp Ther Med,2017,14(1):79-86.
[6]韩莉,康焰.急性生理功能和慢性健康状况评分系统Ⅱ和Ⅳ对192例重度急性胰腺炎死亡风险预测的比较[J].中华消化杂志,2016,36(3):177-181.
[7]赵倩,谢月群,张涛,等.降钙素原对脓毒症患者病情及预后的临床价值[J].中华急诊医学杂志,2016,25(7):937-943.
[8]王海波,徐丽娟,李克鹏,等.KDIGO标准APACHEⅡ与SOFA评分对脓毒症急性肾损伤患者的预后评估[J].中国急救医学,2013,33(6):499-502.
[9]胡牡丹,沈惠青.预见性护理在胸腹腔镜联合食管癌切除患者手术中期护理管理的应用[J].护理与康复,2017,16(3):288-290.
[10]李晓如,李志军,王东强,等.APACHEⅡAPACHEⅢ评分及PSI评分评估老年重症肺炎预后的对比研究[J].中国急救医学,2015,35(11):1013-1016.
[11]李慧珍,张海英,赵艳伶,等.APACHEⅡ评分引入MODS评分系统对ICU危重症患者预后的预测价值[J].河北医学,2017,23(4):568-572.
[12]Knaus W A,Draper E A,Wagner D P,et al.APACHEⅡ:a severity of disease classification system[J].Crit Care Med,1985,13(10):818-829.
[13]方卫刚.APACHEⅡ评分变化率与ICU危重病患者预后相关性研究[J].中国急救医学,2013,33(10):919-921.
[14]任艺,邵旦兵,刘红梅,等.MEWS评分SCS评分和APACHEⅡ评分在评估急诊危重患者预后中的作用[J].中国急救医学,2013,33(8):711-714.
[15]孟新科,杨径,吴华雄,等.MEWS与APACHEⅡ评分在急诊潜在危重病患者病情评价和预后预测中的对比研究[J].实用临床医药杂志,2005,9(8):1-4.
[16]周洪,綦俊,张奇,等.心肌型脂肪酸结合蛋白联合APACHEⅡ评分对急性肺栓塞病情严重程度及预后的评估价值[J].中华胸心血管外科杂志,2017,33(4):204-207.
[17]王长远,曹涛,汤辉,等.NEWS评分MEWS评分和APACHEⅡ评分对急诊内科抢救室患者的评估价值[J].中国急救医学,2017,37(2):123-126.
[18]肖光明,贾卫东,何凯茵,等.应用Cox比例风险模型分析抗病毒治疗对慢性乙型重型肝炎预后的影响[J].实用肝脏病杂志,2009,12(3):190-194,206.
[19]李博志,胡怀强,程明,等.3种评分量表对热射病预后评估的比较[J].医学研究生学报,2016,29(5):518-521.
[20]林金锋,杨志洲,邵旦兵,等.MODS评分与应激性溃疡的相关性研究[J].中华急诊医学杂志,2014,23(8):847-851.