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[临床基本知识] 细说 APACHE II 评分
2012年08月28日
⁄ 临床话题, 基本知识
⁄ 评论数 12
Explication for APACHE II
整理及讲解：杜斌
（CSCCM原创，转载请注明）
[ 有关名称 ]
•.
APACHE 的英文全称为 Acute Physiology and Chronic Health Evaluation，中文译为 急性生理与慢性健康评分
•.
有个别文献也将 APACHE 的全文写为 Acute Physiology, Age and Chronic Health Evaluation，尽管出处不详
[ 内容 ]
•.
APACHE II 评分 包括三部分，即 急性生理评分、年龄评分 及 慢性健康评分
急性生理评分 （Acute Physiology Score, APS）
•.
基本原则
o
APS包括12项生理指标，应当选择入ICU最初24小时内的最差值
o
对于大多数生理指标而言，入ICU最初24小时内的最差值指最高值或最低值
o
同时记录各个指标在最初24小时内的最高值和最低值，并根据附表分别进行评分，应当选择较高的分值
•.
具体说明
o
体温：原文指肛温，国内ICU多采用腋温，不建议将腋温加 0.3 或 0.5 度进行评分
因为这样会进一步增加误差（核心体温与腋温的差值并不固定，受到病情的影响）
o
平均动脉压：如果护理记录中没有记录平均动脉压，则应当根据记录的收缩压和舒张压进行计算
收缩压高时平均动脉压不一定高，反之亦然
o
心率：根据心室率评分
o
呼吸频率：按照实际呼吸频率评分（无论是否使用机械通气）
o
氧合：FiO2不同时使用不同的指标评价氧合
采用鼻导管或面罩吸氧时需要估测FiO2 此时可采用经验公式 ( FiO2 = O2流量 x 4 + 21，仅适用于鼻导管且氧流量 70
Arterial pH
≥ 7.7
< 7.15
7.6 - 7.69
7.15 - 7.24
7.25 - 7.32
7.5 - 7.59
7.33 - 7.49
Serum Na (mmol/L)
≥ 180
≤ 110
160 - 179
111 - 119
155 - 159
120 - 129
150 - 154
130 - 149
Serum K (mmol/L)
≥ 7
< 2.5
6 - 6.9
2.5 - 2.9
5.5 - 5.9
3 - 3.4
3.5 - 5.4
Serum Cr (mg/dL) (double point score for ARF)
≥ 3.5
2 - 3.4
1.5 - 1.9
< 0.6
0.6 - 1.4
Hct (%)
≥ 60
< 20
50 - 59.9
20 - 29.9
46 - 49.9
30 - 45.9
WCC (x 109/L)
≥ 40
< 1
20 - 39.9
1 - 2.9
15 - 19.9
3 - 14.9
GCS (Score = 15 – actual GCS)
A Acute physiology score (APS)
Serum HCO3 (venous, mmol/L) (not preferred, use if no ABGs)
≥ 52
< 15
41 - 51.9
15 - 17.9
18 - 21.9
32 - 40.9
22 - 31.9
B Age Points
Assign points to age as follows:
Age (yrs)
≤ 44
45 - 54
55 - 64
65 - 74
≥ 75
Points
0
2
3
5
6
C Chronic Health Points
If the patient has a history of severe organ system insufficiency or is immunocompromised assign points as follows:
a.
for nonoperative or emergency postoperative patients – 5 points
b.
for elective postoperative patients – 2 points
Definitions:
Organ insufficiency or immunocompromised state must have been evident prior to this hospital admission and conform to the following criteria:
Liver
Biopsy proven cirrhosis and documented portal hypertension; episodes of past upper GI bleeding attributed to portal hypertension; or prior episodes of hepatic failure / encephalophathy / coma
Cardiovascular
New York Heart Association Class IV
Respiratory
Chronic restrictive, obstructive, or vascular 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 dependency
Renal
receiving chronic dialysis
Immunocompromised
The patient 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, AIDS
APACHE II Score
A Acute physiology score (APS)
B Age Points
C Chronic Health Points
Total APACHE II score = A + B + C =
Emergency surgery: Yes No
Diagnostic category weight:
Probability of Death:
Principal Diagnostic Categories Leading to ICU Admission
Nonoperative patients
Postoperative patients
Respiratory failure or insufficiency from:
Asthma/allergy
-2.108
Multiple trauma
-1.684
COPD
-0.367
Admission due to chronic cardiovascular dis.
-1.376
Pulmonary edema (noncardiogenic)
-0.251
Peripheral vascular surgery
-1.315
Postrespiratory arrest
-0.168
Heart valve surgery
-1.261
Aspiration/poisoning/toxic
-0.142
Craniotomy for neoplasm
-1.245
Pulmonary embolus
-0.128
Renal surgery for neoplasm
-1.204
Infection
0
Renal transplant
-1.042
Neoplasm
0.891
Head trauma
-0.955
Cardiovascular failure or insufficiency from:
Thoracic surgery for neoplasm
-0.802
Hypertension
-1.798
Craniotomy for ICH/SDH/SAH
-0.788
Rhythm disturbance
-1.368
Laminectomy and other spinal cord surgery
-0.699
Congestive heart failure
-0.434
Hemorrhagic shock
-0.682
Hemorrhagic shock/hypovolemia
0.493
GI bleeding
-0.617
Coronary artery disease
-0.191
GI surgery for neoplasm
-0.248
Sepsis
0.113
Respiratory insufficiency after surgery
-0.140
Postcardiac arrest
0.393
GI perforation/obstruction
0.060
Cardiogenic shock
-0.259
Dissecting thoracic/abdominal aneurysm
0.731
Trauma:
For postoperative patients admitted to the ICU for sepsis or postarrest, use the corresponding weights for nonoperative patients.
Multiple trauma
-1.228
Head trauma
-0.517
Neurologic:
Seizure disorder
-0.584
ICH/SDH/SAH
0.723
Other:
Drug overdose
-3.353
Diabetic ketoacidosis
01.597
GI bleeding
0.334
If not in one of the specific groups above, then which major vital organ system was the principal reason for admission?
If not in one of the above, which major vital organ system led to ICU admission postsurgery?
Metabolic/renal
-0.885
Neurologic
-1.150
Respiratory
-0.890
Cardiovascular
-0.797
Neurologic
-0.759
Respiratory
-0.610
Cardiovascular
0.470
Gastrointestinal
-0.613
Gastrointestinal
0.501
Metabolic/renal
-0.196
To compute predicted death rates for groups of acutely ill patients, for each individual compute the risk (R) of hospital death with the following equation; then sum the individual risks and divide by the total number of patients
ln (R / 1-R) = -3.517 + (APACHE II score x 0.146) + (0.603, only if postemergency surgery) + (Diagnostic category weight)
（CSCCM原创，转载请注明）
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