Establishing And Applicating Of The Improved Evaluation System For The Critically Ill Obstetric Patients

Objective:To establish the improved evaluation system for the critically ill obstetric patients,to assess the severity of the disease. And review information on the new assessment system for evaluation. Compare APACHEⅡwith the improved evaluation system for the critically ill obstetric patients for their effective.Methods:1. Clincal data:A retrospective medical record review was conducted involving 161 cases critically ill obstetric patients,who were admitted to the ICUs of The First Affiliated Hospital of Fujian Medical University from January 2004 to December 2010.2. The establishment of the improved evaluation system for the critically ill obstetric patients:①Selecting parameters: Choose to the worst values of physiological parameters within the first 24 hours after admission to the ICU wards. The 29 physiological parameters can reflect the severity of major systems of the body. The number of variables was reduced from 29 to 15. The most relevant parameters are srcreened from the outcome above.②Assignment: Relative weights of 18 variables were assigned according to the physiological and pathological characteristics during pregnancy, and referred the APACHEⅡsystem and the APACHEⅢsystem of the parameters.3. The application of the improved evaluation system for the critically ill obstetric patients:①The scores depending on the the improved evaluation system were calculated.②To compare the score differences between the survivors and non-survivors groups.Do the ROC curve of APACHEⅡsystem and the modified scoring system to find the cut-off point.③The relationship between the score and the maternal outcomes(organ dysfunction and prognosis) were analyzed.Result:1. The improved evaluation system for the critically ill obstetric patients system involves 15 physiologic variables include: Body temperature, Mean arterial pressure, Respiratoryrate, Heartrate, SaO2, Serum creatinine, Bilirubin total, Bloodglucose concentration, Serum albumin, ALT transaminas, Blood platelets count, fibrinogen, White blood count, Hematocrit, Systema nervosum,Serum potassium. The relative weights of each variable(0-4)were assigned and the maximum total score is 56.2. A signlficant difference was found between survivors and non-survivors groups on the score of patients scored by the improved evaluation system for the critically ill obstetric patients respectively(P<0.05).The score of the survivors is 8.33±5.74,whereas the non-survivors is 17.93±5.00.3. The c-index for APACHEⅡ(0.859) is smaller than for the improved evaluation system in critically ill obstetric patients(0.914).With the score increased, the rate of the maternal organ dysfunction is increasing. and they are significantly positively correlated(b=0.784).4. 2 organ dysfunction : Score 9 sub-division,compared with 0-8 significant difference(P=0.031);3 organ dysfunction:Score 14 sub-division,compared with 0-13 significant difference(P=0.043).5. There are significant differences of charges and the days in ICU in defferent groups.Conclusion:1. The improved evaluation system for the critically ill obstetric patients composed of 15 physiological variables has been established.2. The improved evaluation system is better than APACHEⅡsystem in predicting the prognosis in obstetric.With The higher the scores, the more severe the disease. is a cutpoint that the rate of a single organ dysfunction was significantly increased. The patients whose score is more than 5 should be transffered from small hospital to large hospital. The patients whose score are between 9 and 12 are admissed to the ICU. When the score is more than 14. Life-support treatment should be done according to the specific circumstances...