重癥病患疾病嚴(yán)重度評(píng)估課件

重癥病患疾病嚴(yán)重度評(píng)估重癥病患疾病嚴(yán)重度評(píng)估 重癥病患疾病嚴(yán)重度評(píng)估目的預(yù)測(cè)死亡率及存活機(jī)率評(píng)估治療成果評(píng)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(píng)估APACHE(AcutePhysiologyandChronicHeathEvaluation)NYHA(NewYorkHeartAssociation)classificationofheartfailureCCS(CanadianCardiovascularSociety)classificationofanginapectorisKillip’sclassificationofacutemyocardialinfarctionGCS(GlasgowComaScale)TISS(TherapeuticInterventionScoring)重癥病患疾病嚴(yán)重度評(píng)估APACHEsystemAPACHE:1981,prototypeAPACHEⅡ:1985APACHEⅢ:1991

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

C:chronichealthpoints重癥病患疾病嚴(yán)重度評(píng)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(píng)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(shí)的肝硬化，被証實(shí)的門(mén)脈高壓（portalhypertension），曾發(fā)生因門(mén)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(shí)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(dòng)限制，即無(wú)法爬樓梯或做家事，或已証實(shí)的慢性低氧血癥，高二氧化碳血癥，次發(fā)性紅血球過(guò)多癥，嚴(yán)重肺動(dòng)脈高壓(大於40mmHg)或依賴(lài)呼吸器。腎臟疾?。航邮苈酝肝鲋委?。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(xiàn)治療，長(zhǎng)期或最近高劑量類(lèi)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(jì)分

B年齡計(jì)分

C慢性健康計(jì)分

APACHEⅡScore＝A＋B＋C

電腦畫(huà)面操作點(diǎn)選住院中患者作業(yè)選擇單位選擇病患進(jìn)入操作畫(huà)面重癥病患疾病嚴(yán)重度評(píng)估於<INPN37SB>畫(huà)面點(diǎn)選氧分壓『註』顯示之畫(huà)面重癥病患疾病嚴(yán)