Study On The Establishment Of The Evaluation And Hierarchical Monitor System On Adult Patients After Cardiac Surgery

Objective To analysis the clinic significance of the prognosis assess and severity of illness evaluate with acute physiology and chronic health evaluation II for the postoperative patients in cardiovascular surgery; to establish the key elements of standard hierarchical monitoring system for the postoperative patients in cardiovascular surgery.Methods Phase1:234postoperative patients of cardiovascular surgery admitted to the CSICU in the first and second Xiang Ya Hospital of Central South University were investigated from June2011to September2011. APACHE II score were collected when postoperative patients in cardiovascular surgery were admitted to CSICU during the first24hrs. The follow up observation was taken on prognosis, and complications. Phase2:On the base of literature review and investigation of clinical condition assessment, use the Delphi method to establish the key elements of standard hierarchical monitoring system for the postoperative patients in cardiovascular surgery. The research tools included APACHE Ⅱ scoring, and Self-made questionnaire. Descriptive analysis, one-way ANOVA, Spearman correlation analysis and AUROCC analysis were used to analize data with software SPSS16.0.Results1.The mean APACHE Ⅱ score of234postoperative patients of cardiovascular surgery was14.22±6.77.2.The differences in the APACHE Ⅱ score between the survivors、 the patient with complication and the dead group were significant.3.The differences in the APACHE II score between the groups of patients with different preoperative cardiac function were significant.4.The detention time in CSICU is positively related to scors of APACHE Ⅱ.5.The ROC area under the curve of APACHE Ⅱ is0.991±0.006.6. Use the predict rate which>30%as the standard for death, sensitivity of APACHE Ⅱ scoring system for mortality risk prediction is80.00%, specificity is99.12%, the accuracy is98.72%.7. According to the scores divide the patients into three groups (<10 points,10to20points,>20points), only the>20points group’s forecast mortality is in actual mortality’s95%confidence interval.8.The positive coefficients of the two rounds inquiry were95%and100%, in the two rounds inquiry there were8and2experts put forward the constructive suggestion, take up40%and10.53%.9.The authority coefficients of the two rounds inquiry were0.78and0.79.10.The coordinate coefficient of the one class index in the two rounds inquiry were0.539,0.698, of the two class index in the two rounds inquiry were0.783and0.829, P is less than0.01.11. After two rounds of inquiry, advices from experts gradually tend to be consistent, and ultimately form the standard hierarchical monitoring system for the postoperative patients in cardiovascular surgery.Conclusions1. The patients who have undergone cardiovascular operation would be well assessed by APACHE Ⅱ for illness severity evaluating and prognosis. Clinical medical and nursing staff can use APACHE Ⅱ scoring system to assess prognosis of postoperative patients in cardiovascular surgery and provide intervention for them.2. Divided into three monitoring levels according to the APACHE Ⅱ score, and identified the content and frequency of standard indicators at all monitor levels to established hierarchical monitoring system for the postoperative patients in cardiovascular surgery.