重症病患疾病严重度评估 PPT课件.ppt

重症病患疾病嚴重度評估
心臟外科呂明仁
目的
預測死亡率及存活機率
評估治療成果
評估醫療資源利用的適當與否
APACHE (Acute Physiology and Chronic Heath Evaluation)
NYHA ( New York Heart Association) classification of heart failure
CCS ( Canadian Cardiovascular Society ) classification of angina pectoris
Killip’s classification of acute myocardial infarction
GCS (a Scale)
TISS (Therapeutic Intervention Scoring)
APACHE system
APACHE : 1981 , prototype
APACHE Ⅱ: 1985
APACHE Ⅲ: 1991
— developed by ICU Research
unit , e Washington
University Medical center
APACHE Ⅱ疾病嚴重度分類系統
APACHE Ⅱ
Acute Physiology and Chronic Health Evaluation: score calculation
APACHE Ⅱ Score = A + B + C
A: acute physiology score points
B: age points
C: chronic health points
Acute Physiology Score(APS)
Serum creatinine :double the points for ARF
Oxygenation points:
PaO2 directly when FiO2
Alveolar-arterial O2 gradient
(P[A-a]O2)when FiO2
P[A-a]O2=[(700FiO2)-(Pa(O2)]-PaO2
The APS is determined from the most worst physiologic value during the initial 24hrs after ICU admission
Chronic Health points
If the patient has a history of an system insufficiency or is promized
1. non-operative or emergency postoperative
patients--------------------------------------- 5 points
2. for elective postoperative patients-- 2 point
If the patient dose not have severe chronic health problem------------------------------------------ 0 point