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目的研究运用急性生理学与长期慢性健康状况评分Ⅱ(APACHEⅡ)评估重症监护病房(ICU)患者疾病的危重程度与医院感染发生率及病死率的相关性,对根据不同分值的患者采取相应干预措施的指导意义。方法前瞻性监测2013年1月-2014年1月入住ICU患者1 479例纳入观察组,搜集住院患者第一个24h内的生命体征、血常规、肝肾功能、电解质及血气分析格拉斯哥昏迷评分等检查数据,并将所有数据输入APACHEⅡ评分量表得出分值,并根据APACHEⅡ评分分值与医院感染相关性有针对性地制定预防控制措施。2011年1月-2012年1月入住ICU 24h以上的患者1 225例纳入对照组,实施常规重症患者预防措施。结果观察组共监测1 479例,医院感染率为21.97%,病死率为3.38%;对照组共监测1 225例,医院感染率为46.04%,病死率为7.51%,观察组医院感染发生率及病死率明显低于对照组(P<0.05)。从研究中发现当APACHEⅡ评分分值≥15分以后患者医院感染发生率及病死率呈显著的上升趋势,当APACHEⅡ评分分值≥35分以后患者的医院感染发生率高达50.00%,病死率达到15.00%,当APACHEⅡ评分分值≥40分以后医院感染的发生率达到100.00%,而患者的病死率高达57.12%。APACHEⅡ评分分值增高,ICU患者医院感染的发生率及病死率均有不同程度的增加。结论运用APACHEⅡ评分系统能及时准确地评估患者疾病严重程度、病情发展的趋势和预后,有助于指导医务人员早期介入,及时准确的治疗及细化各项监护措施,对尽早实施医院感染预防控制有重要的指导作用。
Objective To study the relationship between the severity of illness and the incidence of nosocomial infection and mortality in intensive care unit (ICU) patients with acute physiology and long-term chronic health status score Ⅱ (APACHEⅡ), and to take corresponding intervention measures according to patients with different scores The guiding significance. Methods Prospective monitoring From January 2013 to January 2014, 1 479 admitted ICU patients were enrolled in the observation group to collect the vital signs, blood routine, liver and kidney function, electrolytes and blood gas analysis Glasgow coma score in the first 24h of hospitalized patients Check the data, and all data input APACHE Ⅱ scoring scale score, and according to APACHE Ⅱ score and hospital infection related to the development of prevention and control measures. From January 2011 to January 2012, 1,225 patients admitted to the ICU for more than 24 hours were enrolled in the control group and were given routine preventive measures. Results A total of 1 479 cases were observed in the observation group. The hospital infection rate was 21.97% and the case fatality rate was 3.38%. In the control group, a total of 1 225 cases were monitored. The hospital infection rate was 46.04% and the case fatality rate was 7.51%. The incidence of nosocomial infection and Mortality was significantly lower than the control group (P <0.05). From the study found that when the APACHE Ⅱ score score ≥ 15 points after the incidence of hospital infection and mortality showed a significant upward trend, when the APACHE Ⅱ score score ≥ 35 points after the incidence of nosocomial infections in patients up to 50.00%, the mortality rate reached 15.00 %, When the APACHE Ⅱ score score ≥ 40 points after the incidence of nosocomial infection reached 100.00%, while the patient’s mortality rate as high as 57.12%. APACHEⅡscore score increased, the incidence of hospital infection and mortality in ICU patients have varying degrees of increase. Conclusion APACHE Ⅱ scoring system can be timely and accurately assess the severity of the disease in patients with the trend and prognosis of the disease helps to guide the early intervention of medical personnel, timely and accurate treatment and refinement of the monitoring measures, the implementation of hospital infection prevention and control as soon as possible There is an important guiding role.