APACHEII評分說明

1、APACHE II評分說明發(fā)布時間：08-23-2010點擊數(shù)：8754次 字體：小大有關(guān)名稱 APACHE 的英文全稱為 Acute Physiology and Chronic Health Evaluation，中文譯為急 性生理與慢性健康評分。 有個別文獻(xiàn)也將APACHE 的全文寫為 Acute Physiology, Age and Chronic HealthEvaluation，盡管出處不詳。內(nèi)容 APACHE II評分包括三部分，即急性生理評分、年齡評分及慢性健康評分。急性生理評分（Acute physiology score, APS）*基本原則o APS包括12項生理指標(biāo)，

2、應(yīng)當(dāng)選擇 入ICU最初24小時內(nèi)的最差值o對于大多數(shù)生理指標(biāo)而言，入ICU最初24小時內(nèi)的最差值指最高值或最低值o同時記錄各個指標(biāo)在最初24小時內(nèi)的最高值和最低值，并根據(jù)附表分別進(jìn)行評分，應(yīng)當(dāng)選擇較高的分值具體說明o體溫：原文指肛溫，國內(nèi)ICU多采用腋溫。不建議將腋溫加0.3或0.5度進(jìn)行 評分，因為這樣會進(jìn)一步增加誤差（核心體溫與腋溫的差值并不固定，受到 病情的影響）。o平均動脈壓：如果護(hù)理記錄中沒有記錄平均動脈壓，則應(yīng)當(dāng)根據(jù)記錄的收縮壓和舒張壓進(jìn)行計算。收縮壓高時平均動脈壓不一定高，反之亦然。o心率：根據(jù)心室率評分o呼吸頻率：按照實際呼吸頻率評分（無論是否使用機(jī)械通氣）o氧合：FiO2不同

3、時使用不同的指標(biāo)評價氧合。采用鼻導(dǎo)管或面罩吸氧時需要 估測FiO2。此時可采用經(jīng)驗公式（FiO2 = 02流量x 4 + 21，僅適用于鼻導(dǎo)管 且氧流量 6 lpm時），或見下表。如FiO2 0.5,根據(jù)A-aDO2進(jìn)行評分，此時估測FiO?將影響計算值以 及氧合評分結(jié)果（FiO2受到面罩密閉性及面罩種類的影響因而不確 定，但建議科室應(yīng)當(dāng)確定經(jīng)驗性數(shù)值以確保不同評分者的一致性。例如，規(guī)定使用儲氧面罩時FiO?定為0.80）A-aDO 2 = FiO2 x (Pb-Ph2o) - PaCO2/RQ = FQ2 x (760 - 74) - PaCO2/O.8 = 713 x FQ2 - PaCO

4、2/O.8其中：A-aDO2：肺泡動脈氧分壓差，F(xiàn)iO2：吸入氧濃度，Pb :大氣壓，Ph2o :水蒸氣壓，RQ:呼吸熵鼻導(dǎo)管面罩氧流量（lpm）123456815重復(fù)吸入FQ20.230.250.270.300.350.400.450.500.70注：使用鼻導(dǎo)管時氧流量應(yīng) 6 lpm。o動脈血pH :同時記錄最高值和最低值后分別評分，并取分值高者o血鈉：同時記錄最高值和最低值后分別評分，并取分值高者o血鉀：同時記錄最高值和最低值后分別評分，并取分值高者o血肌酐：同時記錄最高值和最低值后分別評分，并取分值高者注意肌酐過低也有分（SCr 0.6 mg/dL或53卩mol/時為2分）急性腎功能衰竭

5、時，應(yīng)根據(jù)肌酐先行評分后將分值x 2 ,而非將肌酐數(shù)值x2后再進(jìn)行評分急性腎功能衰竭的定義為：每日尿量 1.5mg/dL或132.6卩mo,L且未接受長期透析（腹膜透析或血液透析）o血球壓積：同時記錄最高值和最低值后分別評分，并取分值高者o白細(xì)胞計數(shù)：同時記錄最高值和最低值后分別評分，并取分值高者o格拉斯哥昏迷評分（GCS）使用鎮(zhèn)靜和（或）肌松藥物時應(yīng)遵循best guess的原則進(jìn)行判斷評分，即根據(jù)臨床表現(xiàn)及藥物使用情況，估計在沒有藥物影響時的GCS。（這當(dāng)然并不容易，且容易導(dǎo)致不同評分者之間的差異，但沒有更 好的解決方法。）兩側(cè)肢體活動不對稱時，應(yīng)根據(jù)病情較輕側(cè)的情況進(jìn)行評分。有人工氣道的

6、患者進(jìn)行語言評分時應(yīng)采用5-3-1評分（見下表）。應(yīng)計算15 -GCS的結(jié)果后與其他急性生理評分相加最佳語言反應(yīng)插管患者語言”最佳運動反應(yīng)最佳睜眼5定向力好5定向力好6遵囑活動4自主4言語錯亂3介于兩者之間5疼痛定位3命令3只能說出單詞1無反應(yīng)4屈曲：收回2疼痛2只能發(fā)音氣管插管或氣管切開3屈曲：去皮層1無反應(yīng)1無反應(yīng)患者語言評分應(yīng)使用2伸展此列1無反應(yīng)o血HCO3：當(dāng)沒有血氣結(jié)果時使用此項 （不建議不查血氣， 因為這將沒有氧合 及pH兩項評分結(jié)果）*急性生理評分應(yīng)為各項評分的總和如有缺項，應(yīng)視為正常，即評0分年齡評分年齡（歲）41 39 -40.9 38.5 -38.9。36 -38.416

7、0130 -159110 -12970 -109180140 -179110 -13970 -109 5035 -4925 -3412 -24ventilated) 0.5: A-aDO 2500350 -499200 -349 200b. FiO2 0.5: PaO2 70Arterial pH7.77.6 -7.697.5 -7.597.33 -7.49180160 -179155 -159150 -154130 -14976 -6.95.5 -5.93.5 -5.43.52 -3.41.5 -1.90.6 -1.4point score for ARF) 6050 -59.946 -49

8、.930 -45.9 4020 -39.915 -19.93 -14.9 5241 -51.932 -40.922 -31.9(not preferred, use if no ABGs) 1515 -17.918 -21.9B Age PointsAssig n points to age as follows:Age (yrs) 75Poi nts02356C Chronic Health PointsIf the patie nt has a history of severe orga n system in sufficie ncy or is immuno compromised

9、assig n points as follows:a. for non operative or emerge ncy postoperative patie nts 5 pointsb. for elective postoperative patients 2 pointsDefinitions:Orga n in sufficie ncy or immuno compromised state must have bee n evide nt prior to this hospital admission and conform to the following criteria:L

10、iverBiopsy proven cirrhosis and documented portal hypertension; episodes of past upper GI bleeding attributed to portal hypertension; or prior episodes of hepatic failure / encephalophathy / comaCardiovascularNew York Heart Association Class IVRespiratoryChronic restrictive, obstructive, or vascular

11、 disease resulting in severe exercise restriction, i.e., unable to climb stairs or perform household duties; or documented chronic hypoxia, hypercapnia, secondary polycythemia, severe pulmonary hypertension ( 40 mmHg), or respiratory dependencyRenalreceiving chronic dialysisImmunocompromisedThe pati

12、ent has received therapy that suppresses resistance to infection, e.g., immunosuppression, chemotherapy, radiation, long-term or recent high doses steroids, or has a disease that is sufficiently advanced to suppress resistance to infection, e.g., leukemia, lymphoma, AIDSAPACHE II ScoreA APS pointsB

13、Age pointsC Chronic health pointsTotal APACHE II score = A B +C =匚Emergency surgery: YesNoDiagnostic category weight:Probability of Death:Principal Diagnostic Categories Leading to ICU AdmissionNonoperative patientsPostoperative patientsRespiratory failure or insufficiency from:Multiple trauma-1.684

14、Asthma/allergy-2.108Admission due to chronic cardiovascular dis.-1.376COPD-0.367Peripheral vascular surgery-1.315Pulmonary edema (noncardiogenic)-0.251Heart valve surgery-1.261Postrespiratory arrest-0.168Craniotomy for neoplasm-1.245Aspiration/poisoning/toxic-0.142Renal surgery for neoplasm-1.204Pul

15、monary embolus-0.128Renal transplant-1.042Infection0Head trauma-0.955Neoplasm0.891Thoracic surgery for neoplasm-0.802Cardiovascular failure or insufficiency from:Craniotomy for ICH/SDH/SAH-0.788Hypertension-1.798Laminectomy and other spinal cord surgery-0.699Rhythm disturbance-1.368Hemorrhagic shock

16、-0.682Congestive heart failure-0.434GI bleeding-0.617Hemorrhagic shock/hypovolemia0.493GI surgery for neoplasm-0.248Coronary artery disease-0.191Respiratory insufficiency after surgery-0.140Sepsis0.113GI perforation/obstruction0.060Postcardiac arrest0.393Cardiogenic shock-0.259Dissecting thoracic/ab

17、dominal aneurysm0.731Trauma:For postoperative patients admitted to theICU forMultiple trauma-1.228sepsis or postarrest, use the corresponding weights forHead trauma-0.517nonoperative patients.Neurologic:Seizure disorder-0.584ICH/SDH/SAH0.723Other:Drug overdose-3.353Diabetic ketoacidosis01.597GI blee

18、ding0.334If not in one of the specific groups above, then whichIf not in one of the above, which major vital organmajor vital organ system was the principal admission?reason forsystem led to ICU admission postsurgery?Metabolic/renal-0.885Neurologic-1.150Respiratory-0.890Cardiovascular-0.797Neurologic-0.759Respiratory-0.610Cardiovascular0.470Gastrointestinal-0.613Gastrointestinal0.501Metabolic/renal-0.196To compute predicted death rates for groups of acutely ill pati