APACHEⅡ评分对机械通气患者相关指标及预后的评估分析
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摘要
目的探讨急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ评分系统)对评估重症监护室机械通气患者相关指标的应用价值。方法选取2016年6月-2018年6月入住重症监护室,且使用有创呼吸机>48h的患者258例,在患者入住重症监护室24h内予以APACHEⅡ评分,分为重症组(评分≤15分)和危重症组(评分16～20分)和极危重症组(评分>20分)三组,患者例数分别为39例、111例、108例。前瞻性分析和比较三组患者VAP发生率、多药耐药菌感染发生率、病死率、平均使用呼吸机天数和抗菌药物使用天数、入住重症监护室天数等情况。结果三组患者呼吸机和抗菌药物使用天数比较差异有统计学意义(均P<0.05),且随着APACHEⅡ评分分值的增加而逐渐增加,平均入住监护室天数比较差异无统计学意义;重症监护室机械通气患者随着APACHEⅡ评分分值的增高,VAP发生情况、多药耐药菌检出率和病死率逐渐增高,比较差异有统计学意义(均P<0.05)。结论应用APACHEⅡ评分能够对患者的病情进行全面评价,并能较好地评估患者的预后。
OBJECTIVE To explore the value of Acute Physiology and Chronic Health Evaluation(APACHE)II score in evaluation of related indicators of mechanical ventilation patients of intensive care unit.METHODS A total of 258 patients who were hospitalized in intensive care unit and treated with invasive mechanical ventilation for more than 48 hours from Jun 2016 to Jun 2018 were enrolled in the study,the APACHEⅡscoring was carried out for the patients within 24 hours after the ICU stay,the enrolled patients were divided into the severe group with 39 cases(no more than 15 points),the critical disease group with 111 cases(16-20 points)and the extremely critical disease group with 108 cases(more than 20 points).The incidence of VAP,incidence of multidrug-resistant organisms infection,mortality rate,average time of use of ventilator and length of ICU stay were prospectively analyzed and compared among the three groups of patients.RESULTS There were significant differences in the durations of use of ventilator and antibiotics among the three groups of patients(all P<0.05),the durations were increased with the APACHE II score,but there was no significant difference in the mean length of ICU stay.The incidence of VAP,isolation rate of multidrug-resistant organisms and mortality rate of the ICU patients who underwent the mechanical ventilation were increased with the APACHE II score,and there were significant differences(all P<0.05).CONCLUSIONAPACHE II score can be used for comprehensive evaluation of the illness condition of the patients and evaluate the prognosis of the patients.
OBJECTIVE To explore the value of Acute Physiology and Chronic Health Evaluation(APACHE)II score in evaluation of related indicators of mechanical ventilation patients of intensive care unit.METHODS A total of 258 patients who were hospitalized in intensive care unit and treated with invasive mechanical ventilation for more than 48 hours from Jun 2016 to Jun 2018 were enrolled in the study,the APACHEⅡscoring was carried out for the patients within 24 hours after the ICU stay,the enrolled patients were divided into the severe group with 39 cases(no more than 15 points),the critical disease group with 111 cases(16-20 points)and the extremely critical disease group with 108 cases(more than 20 points).The incidence of VAP,incidence of multidrug-resistant organisms infection,mortality rate,average time of use of ventilator and length of ICU stay were prospectively analyzed and compared among the three groups of patients.RESULTS There were significant differences in the durations of use of ventilator and antibiotics among the three groups of patients(all P<0.05),the durations were increased with the APACHE II score,but there was no significant difference in the mean length of ICU stay.The incidence of VAP,isolation rate of multidrug-resistant organisms and mortality rate of the ICU patients who underwent the mechanical ventilation were increased with the APACHE II score,and there were significant differences(all P<0.05).CONCLUSIONAPACHE II score can be used for comprehensive evaluation of the illness condition of the patients and evaluate the prognosis of the patients.
引文
[1]王有峰,郭宏杰,申改青.呼吸机相关肺炎患儿细胞免疫与炎性状态的变化观察[J].中华医院感染学杂志,2017,27(13):3073-3076.
[2]Leblebicioglu H,Yalcin AN,Rosenthal VD,et al.Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10cities of Turkey:findings of the International Nosocomial Infection Control Consortium(INICC)[J].Infection,2013,41(2):447-456.
[3]Villar CC,Pannuti CM,Nery DM,et al.Effectiveness of intraoral chlorhexidine protocols in the prevention of ventilatorassociatied pneumonia:meta-analysis and systematic review[J].Respir Care,2016,61(9):1245-1259.
[4]陈文森,刘波,周宏,等.呼吸机相关性肺炎和颅脑手术部位感染直接经济损失研究[J].中国消毒学杂志,2017,34(5):447-449.
[5]王力红,马文晖,张京利,等.APACHⅡ评分与医院感染相关性研究[J].中华医院感染学杂志,2007,17(6):651-653.
[6]中华医学会呼吸病学分会.中国成人医院获得性肺炎与呼吸机相关肺炎诊断和治疗指南(2018版)[S].中华医学会,2018.
[7]中华人民共和国卫生部.医院感染监测规范[S].中华人民共和国卫生部,2006.
[8]黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-9.
[9]袁烁,张威威.重症监护室呼吸机相关性肺炎的危险因素及其防控措施[J].医学临床研究,2016,33(6):1069-1071.
[10]Al-Sayaghi KM.Prevention of venlilatior-associated pneumonia.A knowledge survey among intensive care nurses in Yemen[J].Saudi Med J,2014,35(3):369-376.
[11]Bobik P,Siemiatkowski A.Ventilator-associated pneumonia and other infections[J].Pneumonol Alergol Pol,2014,82(5):472-480.
[12]Ding S,Kilickaya O,Senkal S,et al.Temporal trends of ventilator-associated pneumonia incidence and the effect of implementing health-care bundles in a suburban community[J].Chest,2013,144(5):1461-1468.
[13]Ramirez-Estrada S,Borgatta B,Rello J.Pseudomonas aeruginosa ventilator-associated pneumonia management[J].Infect Drug Resist,2016,11(9):7-18.
[14]Schallom M,Dykeman B,Metheny N,et al.Head of bed elevation and early outcomes of gastric reflux,aspiration and pressure ulcers:a feasibility study[J].Am J Crit Care,2015,24:57-66.
[15]Sen S,Johnston C,Greenhalgh D,et al.Ventilator-associated pneumonia prevention bundle significantly reduces the risk of ventilator-associated pneumonia in critically ill burn patients[J].J Burn Care Res,2016,37(3):166-171.
[16]Sulis CA,Walkey AJ,Abadi Y,et al.Outcomes of a ventilator-associated pneumonia bundle on rates of ventilator-associated pneumonia and other health care-associated infections in a long-term acute care hospital setting[J].Am J Infect Control,2014,42(5):536-538.
[17]Melsen WG,Rovers MM,Groenwold RH,et al.Attributable mortality of ventilator-associated pneumonia:a meta-analysis of individual patient data from randomised prevention studies[J].Lancet Infect Dis,2013,13(8):665-671.
[18]Kawanishi F,Yoshinaga M,Morita M,et al.Risk factors for ventilator-associated pneumonia in neonatal intensive care unit patients[J].J Infect Chemother,2014,20(10):627-630.
[19]高晓东,胡必杰,崔扬文,等.中国大陆46所医院呼吸机相关肺炎发病率多中心前瞻性监测[J].中国感染控制杂志,2015,14(8):540-543.
[20]Sundar KM,Nielsen D,Sperry P.Comparison of ventilatorassociated pneumonia(VAP)rates between different ICUs:Implications of a zero VAP rate[J].J Crit Care,2012,27(1):26-32.
[21]DeFreitas ER.Profile and severity of the patients of intensive care units:prospective application of the APACHEⅡindex[J].RevLat Am Enfermagem,2010,18(3):317-323.
[22]瞿介明,邵长周,何礼贤.急性生理学及慢性健康状况评价Ⅲ系统在监护病房中铜绿假单胞菌下呼吸道感染患者中的应用[J].中国呼吸与危重监护杂志,2003,2(6):330-334.
[23]Nair GB,Niederman MS.Ventilator-associated pneumonia:present understanding and ongoing debates[J].Intensive Care Med,2015,41(1):34-48.
[24]中华人民共和国卫生与计划生育委员会.重症监护病房医院感染预防与控制规范[S].中华人民共和国卫生与计划生育委员会,2016.
[25]De Cristofano A,Peuchot V,Canepari A,et al.Implementation of a ventilator-associated pneumonia prevention bundle in a single.PICU[J].Pediatr Crit Care Med,2016,17(5):451-456.
[2]Leblebicioglu H,Yalcin AN,Rosenthal VD,et al.Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10cities of Turkey:findings of the International Nosocomial Infection Control Consortium(INICC)[J].Infection,2013,41(2):447-456.
[3]Villar CC,Pannuti CM,Nery DM,et al.Effectiveness of intraoral chlorhexidine protocols in the prevention of ventilatorassociatied pneumonia:meta-analysis and systematic review[J].Respir Care,2016,61(9):1245-1259.
[4]陈文森,刘波,周宏,等.呼吸机相关性肺炎和颅脑手术部位感染直接经济损失研究[J].中国消毒学杂志,2017,34(5):447-449.
[5]王力红,马文晖,张京利,等.APACHⅡ评分与医院感染相关性研究[J].中华医院感染学杂志,2007,17(6):651-653.
[6]中华医学会呼吸病学分会.中国成人医院获得性肺炎与呼吸机相关肺炎诊断和治疗指南(2018版)[S].中华医学会,2018.
[7]中华人民共和国卫生部.医院感染监测规范[S].中华人民共和国卫生部,2006.
[8]黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-9.
[9]袁烁,张威威.重症监护室呼吸机相关性肺炎的危险因素及其防控措施[J].医学临床研究,2016,33(6):1069-1071.
[10]Al-Sayaghi KM.Prevention of venlilatior-associated pneumonia.A knowledge survey among intensive care nurses in Yemen[J].Saudi Med J,2014,35(3):369-376.
[11]Bobik P,Siemiatkowski A.Ventilator-associated pneumonia and other infections[J].Pneumonol Alergol Pol,2014,82(5):472-480.
[12]Ding S,Kilickaya O,Senkal S,et al.Temporal trends of ventilator-associated pneumonia incidence and the effect of implementing health-care bundles in a suburban community[J].Chest,2013,144(5):1461-1468.
[13]Ramirez-Estrada S,Borgatta B,Rello J.Pseudomonas aeruginosa ventilator-associated pneumonia management[J].Infect Drug Resist,2016,11(9):7-18.
[14]Schallom M,Dykeman B,Metheny N,et al.Head of bed elevation and early outcomes of gastric reflux,aspiration and pressure ulcers:a feasibility study[J].Am J Crit Care,2015,24:57-66.
[15]Sen S,Johnston C,Greenhalgh D,et al.Ventilator-associated pneumonia prevention bundle significantly reduces the risk of ventilator-associated pneumonia in critically ill burn patients[J].J Burn Care Res,2016,37(3):166-171.
[16]Sulis CA,Walkey AJ,Abadi Y,et al.Outcomes of a ventilator-associated pneumonia bundle on rates of ventilator-associated pneumonia and other health care-associated infections in a long-term acute care hospital setting[J].Am J Infect Control,2014,42(5):536-538.
[17]Melsen WG,Rovers MM,Groenwold RH,et al.Attributable mortality of ventilator-associated pneumonia:a meta-analysis of individual patient data from randomised prevention studies[J].Lancet Infect Dis,2013,13(8):665-671.
[18]Kawanishi F,Yoshinaga M,Morita M,et al.Risk factors for ventilator-associated pneumonia in neonatal intensive care unit patients[J].J Infect Chemother,2014,20(10):627-630.
[19]高晓东,胡必杰,崔扬文,等.中国大陆46所医院呼吸机相关肺炎发病率多中心前瞻性监测[J].中国感染控制杂志,2015,14(8):540-543.
[20]Sundar KM,Nielsen D,Sperry P.Comparison of ventilatorassociated pneumonia(VAP)rates between different ICUs:Implications of a zero VAP rate[J].J Crit Care,2012,27(1):26-32.
[21]DeFreitas ER.Profile and severity of the patients of intensive care units:prospective application of the APACHEⅡindex[J].RevLat Am Enfermagem,2010,18(3):317-323.
[22]瞿介明,邵长周,何礼贤.急性生理学及慢性健康状况评价Ⅲ系统在监护病房中铜绿假单胞菌下呼吸道感染患者中的应用[J].中国呼吸与危重监护杂志,2003,2(6):330-334.
[23]Nair GB,Niederman MS.Ventilator-associated pneumonia:present understanding and ongoing debates[J].Intensive Care Med,2015,41(1):34-48.
[24]中华人民共和国卫生与计划生育委员会.重症监护病房医院感染预防与控制规范[S].中华人民共和国卫生与计划生育委员会,2016.
[25]De Cristofano A,Peuchot V,Canepari A,et al.Implementation of a ventilator-associated pneumonia prevention bundle in a single.PICU[J].Pediatr Crit Care Med,2016,17(5):451-456.
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