重癥病患疾病嚴(yán)重度評估課件

重癥病患疾病嚴(yán)重度評估重癥病患疾病嚴(yán)重度評估 重癥病患疾病嚴(yán)重度評估目的預(yù)測死亡率及存活機率評估治療成果評估醫(yī)療資源利用的適當(dāng)與否重癥病患疾病嚴(yán)重度評估APACHE(AcutePhysiologyandChronicHeathEvaluation)NYHA(NewYorkHeartAssociation)classificationofheartfailureCCS(CanadianCardiovascularSociety)classificationofanginapectorisKillip’sclassificationofacutemyocardialinfarctionGCS(GlasgowComaScale)TISS(TherapeuticInterventionScoring)重癥病患疾病嚴(yán)重度評估APACHEsystemAPACHE:1981,prototypeAPACHEⅡ:1985APACHEⅢ:1991

—developedbyICUResearchunit,GeorgeWashingtonUniversityMedicalcenter重癥病患疾病嚴(yán)重度評估APACHEⅡ疾病嚴(yán)重度分類系統(tǒng)重癥病患疾病嚴(yán)重度評估APACHEⅡAcutePhysiologyandChronicHealthEvaluation:scorecalculationAPACHEⅡScore=A+B+CA:acutephysiologyscorepointsB:agepoints

C:chronichealthpoints重癥病患疾病嚴(yán)重度評估AcutePhysiologyScore(APS)Serumcreatinine:doublethepointsforARFOxygenationpoints:1.usePaO2directlywhenFiO20.52.calaculateAlveolar-arterialO2gradient(P[A-a]O2)whenFiO20.5

P[A-a]O2=[(700FiO2)-(Pa(O21.25)]-PaO2TheAPSisdeterminedfromthemostworstphysiologicvalueduringtheinitial24hrsafterICUadmission重癥病患疾病嚴(yán)重度評估ChronicHealthpointsIfthepatienthasahistoryofsevereorgansysteminsufficiencyorisimmunocompromized1.non-operativeoremergencypostoperativepatients---------------------------------------5points2.forelectivepostoperativepatients--2pointIfthepatientdosenothaveseverechronichealthproblem------------------------------------------0point

定義：嚴(yán)重的器官系統(tǒng)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(biāo)準(zhǔn)。肝臟疾?。呵衅^實的肝硬化，被証實的門脈高壓（portalhypertension），曾發(fā)生因門脈高壓引起的上消化道出血，或曾發(fā)生肝衰竭／肝性腦病變／肝昏迷心臟疾?。篘ewYorkHeartAssociation(NYHA)ClassIV－休息時即有不適的癥狀表現(xiàn)。呼吸系統(tǒng)疾?。阂蚵韵拗菩?、阻塞性或血管性肺病導(dǎo)致的嚴(yán)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癥，高二氧化碳血癥，次發(fā)性紅血球過多癥，嚴(yán)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(jié)算：A急性生理狀態(tài)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(yè)選擇單位選擇病患進入操作畫面重癥病患疾病嚴(yán)重度評估於<INPN37SB>畫面點選氧分壓『註』顯示之畫面重癥病患疾病嚴(yán)