APACHE Ⅱ评分与ICU内脊髓损伤行有创机械通气患者谵妄发生的关系

doi:10.3969/j.issn.1006-6233.2020.04.019

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Abstract Objective: To investigate the predictive value of acute physiology and chronic health status scoring system II (APACHE II) in patients with cervical spinal cord injury undergoing invasive mechanical ventilation (MV) in intensive care unit (ICU). Methods: A total of 76 patients with spinal cord injury on mechanical ventilation was enrolled in the study. The APACHE II scores of each patient within 24 hours of admission were collected. Each patient was assessed using Confusion Assessment Method for the ICU (CAM-ICU), and the patients were divided into delirium group (n=30) and non-delirium group (n=46) according to the evaluation results. The APACHE II score, MV time, and ICU hospitalization time of the two groups were analyzed with statistical methods,The 76 enrolled patients were further divided into 5 groups according to their APACHE II scores, with an increment of 5. The correlation between the APACHE II score and the incidence of delirium was analyzed for all patients. The receiver operating characteristic curve (ROC) was plotted, the relevant indicators for predicting delirium occurrence were calculated, and the value of APACHE II score in predicting delirium occurrence was assessed. Results: Among 76 patients with spinal cord injury who underwent MV, the incidence of delirium was 39.47% (30/76). The APACHE II score of the delirium group was higher than that of the non- delirium group (26.63±4.27 vs 19.37±4.23, P<0.05). The MV time of the delirium group was longer than that of the non- delirium group, which was statistically different (15.87±4.58 vs11. 80±4.74, P<0.05); the ICU in hospitalization time in the delirium group was longer than that in the non- delirium group, the difference was statistically significant (18.63±5.87 vs 14.11±5.28, P<0.05). The incidence of delirium was linearly related to the APACHE II score. The ROC curve analysis showed that the area under the curve (AUC) of the APACHE II score predicted delirium was 0.884, and the best intercept point for delirium prediction was when APACHE II score>23, with sensitivity of 76.67% and specificity of 84.78%. Conclusion: The incidence of delirium in patients with spinal cord injury undergoing mechanical ventilation increased with the increase of APACHE II score, which has a high predictive value for the occurrence of delirium in such patients.

Key words： Spinal cord injury Acute physiology and chronic health status scoring system II Mechanical ventilation Delirium Receiver operating characteristic curve

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2020.04.019 OR http://www.hbyxzzs.cn/EN/Y2020/V26/I4/605

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