Clinical Significance Of Acute Physiology And Chronic Health Evaluation Ⅱ In Emergency Patients With MODSE

Acute physiology and chronic health evaluation â…¡ (APACHE â…¡) is widely applied to assess the severity of the illness and prognosis of the critically ill patients in intensive care unit. And multiple organ dysfunction syndrome in elderly (MODSE) is one of the most important clinical syndromes in the critical care medicine in the elder. Assessing the severity of the illness and prognosis of MODSE are receiving increasing attention.Objective:To apply APACHE II to assess the severity of the illness and prognosis of the critically ill elder patients in the EICU, and assess the prognostic value of this score system in patients with SIRS or MODSE. To observe the therapeutic efficacy of SIRS in the patients of MODSE after treated with ulinary trypsin inhibitor (UTI).Methods: 64 cases (age=65 years old ) were retrospectively analyzed in EICU of general hospital of PLA from Aug 2005 to Apr 2006. The cases were divided into the survivors group and the dead group according to the prognosis, and they were divided into the group with MODSE and the group without MODSE by the diagnosis reference of MODSE. APACHE II score was calculated, and prognosis of predicted mortality was made individually, the prognostic value of this system was assessed, especially in the patients with SIRS and MODSE. PA levels , ALB levels in plasma and some indexes associated with SIRS of 10 patients with MODSE were measured when they admitted to the EICU , meanwhile APACHE II scores were documented, these indexes were compared after the patients were treated with UTI.Results: There was significant difference in the APACHE II score between the survivors and the dead group (P<0.01) . There was a significant correlationbetween APACHE II score and actual mortality(P<0.01), and predicted mortality(P< 0.01). Both actual and predicted mortality increased more significantly when the score was higher than 20(P<0.05). The difference of the scores between the SIRS patients and patients without SIRS was also significant (P<0.05), and the mortality of SIRS patients was higher than that of the patients without SIRS (P<0.01) . There were 85.37% cases with MODSE whose primary diagnosis was the disease of respiratory system, especially 46.34% primary diagnosis was pulmonary infection. Between the survivors and the dead in the patients with MODSE there was no significant difference in their APACHE II scores (P>0.05) . There was no difference among the groups divided by the quantity of organ dysfunction (P>0.05) , there was also no difference between the groups divided by the age (P>0.05). The symptoms of SIRS n PA levels in plasma and APACHE II scores were improved significantly in the patients treated with UTI(P<0.05). Conclusions:1 N It may be important of the pulmonary infection in the direct and indirect pathological mechanism of MODSE.2 N APACHE II score system could be applied to predict the prognosis of EICU patients including the patients with SIRS. There is little use among the MODSE patients predicting the severity of the illness.3> The symptoms of SIRS could be improved obviously after the patients treated with UTI. There is also significant difference in the APACHE II score and PA level post treatment. The severity of the illness was lessened after treatment with UTI.