ICU基本评分系统.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,“,Its more important to know what sort of person this disease has,than what sort of disease this person has.”,William Osler 1849-1919,ICU,评分的目的,ICU,评分系统可帮助我们？,Case-mix adjustment for evaluative research,A tool for comparative audit SMR,评估医护工作的效果,standardized mortality ratio:1.0 or 40 mmHg),高度依赖呼吸机,CPS-,Liver insufficiency,-,活检诊断肝硬化,-,门静脉高压,(portal hypertension),-,门脉高压导致上消血病史,-,肝功能衰竭,/,肝性脑病,/,肝昏迷病史,CPS-,Renal,Receiving chronic dialysis,CPS-,Immuno-depression,接受抑制抗感染能力的治疗：免疫抑制药、放化疗、长期或近期是用大剂量类固醇,免疫性疾病：,白血病，淋巴瘤，,AIDS,APACHE,II,AII Predicted death rate,Logit=-3.517+(Apache II)*0.146,Predicted Death Rate=e,Logit,/(1+e,Logit,),5,0,1,2,2,1,0,4,1,1,2,0,2,3,22,1Kpa=7.5 mmHg,APACHEII,局限性,群体敏感度好，个体预测准确率较低,联合应用其他评价系统，提高预测准确性,采样时间点选择？是否有最佳时间点？,对,PHM,（,pridict hospital mortality),的预测值偏高,APS,未考虑血管活性药物、呼吸机、非甾体类药物对各项参数影响,老年患者,计分,比重偏高,营养状态未列入计分考虑,对创伤患者考虑不充分,SAPS,(Simplified Acute Physiology Score),发展历史,In 1984,Le Gall reduced former 34-variable APACHE score to 14 parameters,SAPS I,In 1994,SAPS II(SAPS II score+PHM),In 2008,SAPS III,SAPS II,构成：,0163 scores,Physiological variable:12 variable(026 scores/v),include GCS,Age(0712151618score),Type of admission(,内科,0,、择期,6,、急诊,8,）,3 chronic disease(,AIDS18,Hematologic,malignancy,10,Meta-static cancer,9),PHM,SAPS II Data,Data are collected during the first 24 hours after ICU admission,AgeUse the patients age in years at last birthday,Heart rateUse the worst value in 24 hours,either low or high rate;if it varied from cardiac arrest(11pts)to extreme tachycardia(7pts),assign 11points.,SBPUse the same method as for hearth rate:eg,if it varied from 60 mmHg to 205 mmHg,assign 13 Points.,Body temperatureUse the highest temperature in C or F,PaO2/FiO2 ratioIf ventilated or CPAP,use the lowest value of the ratio.,SAPS II Data,Urinary outputif the patient is in the intensive care unit for less than 24 hours,make the calculation for 24 hours.,Serum urea or BUNUse the highest value in mmol/or g/L for serum urea,in mg/dL for the serum urea nitrogen.,WBC countUse the worst(high or low)WBC count.,Serum potassium levelUse the worst(high or low)value.,Serum Sodium levelUse the worst(high or low)value.,Serum bicarbonate levelUse the lowest value.,BilirubinUse the highest value in micromol/L or mg/dL,Glasgow coma scoreUse the lowest value.If the patient is sedated,record the estimated Glasgow coma score before sedation.,SAPS II Predicted death rate,Logit=-7.7631+0.0737*(SAPS II)+0.9971*ln(SAPS II)+1),Predicted Death Rate=e,(Logit),/(1+e,(Logit),),SAPS,24,小時為緊急與否分界點；一週以上視為,medical,AIDS,Hematologic malignancy,Meta-static cancer,以未被,sedation,之前的,GCS,為基準,沒有呼吸器之病患則以,0,分記,Patients excluded:,Coronary care,cardiac surgery,burn patients,age 15 years,SAPS,Very Simple and quick.(,一个病人,5,min,),Predict mortality without diagnosis.,Application to individual patient is,far difficult.,SAPS and APACHE,SAPS,和,APACHE,、,有強,相关性,，可,能是因为,在,APS,上有很多,重叠选项,SAPS,在,预测预后,上,却,不如,APACHE,II,不同的人,种,，可能也,会,有不同的,结果,Critical Care Medicine.28(2):426-32,2000 Feb.,推荐网址,www.saps3.org,www.sfar.org,