| 宋丽芸,王佳洁,刘 颖,余 慧,郭佳青.APACHEⅡ评分联合动脉血乳酸水平对危重症产妇预后的预测价值分析[J].,2023,(12):2252-2256 |
| APACHEⅡ评分联合动脉血乳酸水平对危重症产妇预后的预测价值分析 |
| Prognostic Predictive Value Analysis of APACHEⅡScore Combined with Arterial Blood Lactic Acid Level in Critically Ill Maternal Patients |
| 投稿时间：2022-12-07 修订日期：2022-12-30 |
| DOI：10.13241/j.cnki.pmb.2023.12.009 |
| 中文关键词: APACHEⅡ评分 动脉血乳酸 危重症产妇 预后 预测价值 |
| 英文关键词: APACHEⅡ score Arterial blood lactic acid Critically ill parturients Prognosis Predictive value |
| 基金项目:2020年度上海市青年科技英才扬帆计划项目（20YF1438200） |
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| 中文摘要: |
| 摘要 目的：探讨急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分联合动脉血乳酸水平对危重症产妇预后的预测价值。方法：选取2019年3月至2022年3月期间上海市第一妇婴保健院收治的危重症产妇84例，根据住院期间危重症产妇的生存预后情况将其分为预后良好组（n=74）及预后不良组（n=10）。所有纳入本研究的危重症产妇均于入院24 h内完成APACHEⅡ评分评估；对所有危重症产妇应用动脉血气分析仪测定其动脉血乳酸水平。对比两组危重症产妇APACHEⅡ评分及动脉血乳酸水平；采用Pearson相关系数分析危重症产妇APACHEⅡ评分与其动脉血乳酸水平的相关性；单因素、多因素Logistic回归分析危重症产妇预后不良的危险因素；采用受试者工作特征（ROC）曲线分析APACHEⅡ评分、动脉血乳酸水平单项指标及联合检测对危重症产妇预后的预测效能。结果：预后不良组APACHEⅡ评分、动脉血乳酸水平均高于于预后良好组（P＜0.05）。采用Pearson相关系数分析显示，危重症产妇APACHEⅡ评分与其动脉血乳酸水平呈正相关（P＜0.05）。多因素Logistic回归分析显示年龄≥35岁、孕前体质指数（BMI）≥25 kg/m2、剖宫产、产后并发心力衰竭、高APACHEⅡ评分、动脉血乳酸水平升高是危重症产妇预后不良的危险因素（P＜0.05）。ROC曲线分析显示，APACHEⅡ评分、动脉血乳酸水平联合检测的预测效能高于单项指标检测。结论：危重症产妇动脉血乳酸水平随着APACHEⅡ评分升高而升高，两者呈正相关关系。高APACHEⅡ评分、动脉血乳酸水平升高是影响危重症产妇预后不良的危险因素，联合检测上述两项指标对危重症产妇预后的预测价值较高。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the predictive value of acute physiology and Chronic Health Scoring System Ⅱ(APACHEⅡ) score combined with arterial blood lactic acid level for the prognosis of critically ill maternal patients. Methods: 84 critically ill maternal patients who were admitted to Shanghai First Maternity and Infant Care Hospital from March 2019 to March 2022 were selected, and they were divided into good prognosis group (n=74) and bad prognosis group (n=10) according to the survival prognosis of critically ill parturients during hospitalization. All critically ill parturients included in this study completed APACHEⅡ score assessment within 24 hours after admission. Arterial blood gas analyzer was used to measure the arterial blood lactic acid level in all critically ill parturients. APACHEⅡ scores and arterial blood lactate level of the critically ill parturients in the two groups were compared. The Pearson correlation coefficient was used to analyze the correlation between APACHEⅡ score and arterial blood lactic acid level in critically ill parturients. Univariate and multivariate Logistic regression were used to analyze the risk factors of poor prognosis in critically ill parturients. Receiver Operating characteristic (ROC) curve was used to analyze the predictive efficacy of APACHEⅡ score, arterial blood lactic acid level and the combined detection for the prognosis of critically ill parturients. Results: APACHEⅡ score and arterial blood lactic acid level in the good prognosis group were lower than those in the poor prognosis group (P＜0.05). Pearson correlation coefficient analysis showed that APACHEⅡ score was positively correlated with arterial blood lactic acid level in critically ill parturients (P＜0.05). Multivariate Logistic regression analysis showed that age greater than or equal to 35 years, pre-pregnancy BMI greater than or equal to 25 kg/m2, cesarean section, postpartum complicated heart failure, high APACHEⅡ score, elevated arterial blood lactic acid level were the risk factors for poor prognosis of critically ill parturients (P＜0.05). ROC curve analysis showed that the combined detection of APACHEⅡ score and arterial blood lactic acid level was more effective than that of single index. Conclusion: The arterial blood lactic acid level in critically ill parturients is increased with the increase of APACHEⅡ score, and the two levels are positively correlated. High APACHEⅡ score and elevated arterial blood lactate level are risk factors for poor prognosis of critically ill parturients. The combined detection of these two indexes has a high predictive value for the prognosis of critically ill parturients. |
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