目的：探讨急性生理学和慢性健康状况评分系统Ⅲ（APACHEⅢ）评估严重烧伤患者预后的意义。方法：对60例重度及特重度烧伤患者进行回顾性研究，根据烧伤严重程度及预后，将其分为重度组和特重度组，存活组和死亡组，比较 APACHEⅢ评分及预计死亡率（R 值）的差异，并对死亡组 APACHEⅢ评分及 R 值与年龄、烧伤总面积，浅Ⅱ度、深Ⅱ度、Ⅲ度烧伤面积进行相关性分析；以40分为界将患者分为两组，比较两组 R 值的差异及各组预计病死率和实际病死率差异。结果：特重度组 APACHEⅢ评分高于重度组，差异有统计学意义（t ＝-2.531，P ＝0.014），而 R 值无明显差异；存活组与死亡组APACHEⅢ评分及R值差异均有统计学意义（ t ＝-7.895，P ﹤0.01；t ＝-4.197，P ﹤0.01）。死亡组 APACHEⅢ评分及 R 值明显高于存活组，R 值随 APACHEⅢ评分升高而升高。APACHEⅢ评分与浅Ⅱ度烧伤面积呈显著负相关，与Ⅲ度烧伤面积呈显著正相关；R 值与年龄、Ⅱ度及深Ⅱ度烧伤面积呈负相关，与烧伤总面积及Ⅲ度烧伤面积呈正相关。评分﹥40分组 R 值明显高于0~40分组，两组比较差异有统计学意义（t ＝-8.363，P﹤0.01）。随着 APACHEⅢ分值的增加，患者的实际病死率和预计病死率明显升高，二者呈正相关。结论：APACHEⅢ评分系统可以作为烧伤严重程度的补充，对评估患者的预后有一定的意义。%Objective:To explore the significance of acute physiology and chronic health evaluation system Ⅲ(APACHEⅢ)in evaluating prognosis of patients with severe burn. Methods:Retrospective study were used to analyze 60 severe and ex-traordinarily severe burn patients who admitted to our hospital. They were divided into severe group and extraordinarily severe group,survival group and non - survival group according to their burn severity and prognosis. APACHEⅢ score and mortality risk(R value)among groups were compared. Correlation analysis was processed among APACHEⅢ scores and R - value, age,total burn surface area,area of superficial second degree,deep second degree and full - thickness burns. The subjects were divided into two groups,regarding the 40 score as boundary. The differences of R value,Predicted mortality rate and the actual mortality rate were compared. Results:Extraordinarily severe group APACHEⅢ score obviously higher than the severe group, the difference was statistically significant(t = - 2. 531,P = 0. 014),while the value of R have no significant difference. Com -paredsurvivalandnon - survivalgroups,APACHEⅢ scores andR - value showedstatistically differences( t = - 7 . 895 ,P ﹤0. 01;t = - 4. 197,P ﹤ 0. 01). APACHEⅢ scores and R values in non - survival group were significantly higher than those in the survival group,and R values increased with APACHEⅢscore changes. Univariate correlation analysis demonstrated that A-PACHEⅢscore significantly negatively correlated with superficial second degree burn area and positively correlated with full -thickness burn area. It is negatively correlated between R value and age,superficial second degree,deep second degree burns area,positively correlated with total burn surface area and full - thickness burn area. Score ﹥ 40 group was significantly higher than the value of R score of 0 to 40 packets in ﹥ 40 packets and a sharp rise in mortality in patients with APACHEⅢ score in-creased,and the difference was statistically significance(t = - 8. 363,P ﹤ 0. 01). Conclusions:APACHEⅢ scoring system can be used as supplementary of evaluating burn severity and has significance for evaluating patient's prognosis.
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