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題 名 | 重症醫療常用疾病嚴重度分數系統簡介=Disease Severity Scoring System in Critical Care Medicine |
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作 者 | 林純全; 謝文斌; | 書刊名 | 胸腔醫學 |
卷 期 | 14:1 1999.03[民88.03] |
頁 次 | 頁44-58 |
分類號 | 415.4 |
關鍵詞 | McCabe分數; APACHE系統; MPM系統; SAPS系統; 器官系統衰竭; 急性肺損傷; McCabe score; APACHE system; MPM system; SAPS system; Organ system failure; Acute lung injury; |
語 文 | 中文(Chinese) |
中文摘要 | 分數系統(scoring system)在加護單位評估疾病嚴重度上扮演一重要 的角色,它同時有預測罹患各種疾病病人的死亡率、評估加護單位的效能、幫助 醫師處理病人和做加護單位間的比較等功能。本文的目的主要介紹重症醫療常用 的分數系統,包括McCabe分數、APACHE系統、MPM系統、SAPS系統、器 官系統衰竭和急性肺損傷。McCabe分數是疾病嚴重度評估量化的濫觴,它將菌 血症的病人依其潛在疾病簡單的分成三類:非致死(nonfatal)(第一項分數,score 1)、終究致死(ultimately fatal)(第二項分數,score 2)、致死(fatal)(第三項 分數,score 3)。APACHE II利用生理變化、年齡、慢性健康狀態等三部分來評 估疾病嚴重度,因為計算簡單且不失其準確性,所以在美國被廣泛使用於重症評 估,但會低估外科急症病人的死亡率,APACHE III可更正確的預估死亡率,但 因太複雜而未廣泛使用。相較於著重數值的分數系統,MPM系統利用多重邏輯 迴歸(multiple logistic regression)模式等客觀方法找出變項,這些變項大部分都 是例行性記錄,資料不易流失。SAPS具簡單、便宜、可靠、省時等優點,在缺 乏診斷下仍可正確預估死亡率,SAPS II同樣有SAPS的優點。有關器官系統衰 竭的研究都顯示,器官衰竭的數目越多,持續的天數越長,死亡率越高。急性肺 損傷利用四個變項包括胸部X光、低血氧(hypoxemia)、呼氣末正壓(PEEP)、 肺順應性(compliance)來評估肺損傷的程度。 |
英文摘要 | A scoring system plays a major role in evaluation of disease severity in intensive care units (ICUs). It may have several applications in predicting mortality of patients who have a variety of critical illnesses, in assessing efficacy of ICUs, in helping physicians in patient care, and in making comparisons among ICUs. The objective of this article is to introduce common-in-use scoring systems which consist of McCabe score, APACHE system, MPM system, SAPS system, organ system failure, and acute lung injury. The original of scoring system is McCabe score which simply categorizes bacteremic patients as nonfatal (score 1), ultimately fatal (score 2) and fatal (score 3) according to underlying diseases. APACHE II combines measure the risk factors of physiologic derangement, age, and chronic health status. It is extensively used in American ICUs due to easy calculation and good prediction. But it also has the defect of underestimating the mortality of traumatic patients. APACHE III can accurately predict hospital mortality, but is not widely used owing to more complex. In contrast to scoring systems based on subjectively determined values, the MPM system provides objective, statistically derived weights for its variables. Moreover, because most of these variables are among those routinely recorded, data are less likely to be missing than with scoring system. SAPS has the advantage of being simple, inexpensive, reliable, and far less time-consuming. It correctly classified patients in groups of increasing probability of death, irrespective of diagnosis. SAPS II is extensively used in European ICUs. It provides an estimate of the risk of death without having to specify a primary diagnosis. The study in organ system failure indicates extraordinarily high mortality rates for patients with three or more OSFs that persist after 3 days of intensive therapy. Lung injury score uses four parameters including chest roentgenogram, hypoxemia, PEEP, and compliance to assess the severity of lung injury. |
本系統中英文摘要資訊取自各篇刊載內容。