log ey / 1 - Y =

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1 APACHE t logistic 18 ph GCS log ey / 1 - Y = Establishing a prediction system for the critically ill obstetric patients KUANG Jian-luan LIU Hui-shu CHEN Dun-jin ZHENG Zheng HUANG Tian-qing HUANG Dong-jian. Department of Obstetrics the Third Affiliated Hospital of Guangzhou Medical University Guangzhou China Corresponding author LIU Hui-shu huisuliu@ hotmail. com Abstract Objective To establish a prediction system for the critically ill obstetric patients. Methods A retrospective study was conducted in 311 critically ill obstetric patients who were admitted to the ICU of the Third Affiliated Hospital of Guangzhou Medical University from January 2000 to July The patients were divided into dead group 72 patients and survival group 239 patients. Assigned the clinical indexes related to the mortality and established a prediction system for the critically ill obstetric patients. The clinical indexes were analyzed by using t test and the mortality prediction equation by using logistic regression model. Results The prediction system involved 18 clinical indexes including body temperature mean artery pressure respiratory rate heart rate PaO 2 /FiO 2 arterial ph serum sodium serum potassium blood glucose serum creatinine serum total bilirubin serum albumin ALT blood platelet count fibrinogen white blood count hematocrit and scores of nervous system. The prediction equation for the mortality risk log ey / 1 - Y = total scores. Conclusions Establishing a prediction system for the critically ill obstetric patients not only improves the diagnostic level but also has an scientific and objective basis in improving medical quality and utilizing the medical resources. Key words Pregnancy high-risk Severity of illness index Forecasting Evaluation DOI /cma. j. issn B huisuliu@ hotmail. com 1-2

2 < P < acute physiology and chronic health evaluation scoring system APACHE APACHEⅡ APACHEⅢ APACHEⅡ APACHEⅢ 0 ~ 4 APACHE ALT GCS GCS ~ 78 intensive care unit ICU ICU 24 h logistic logistic SPSS ± x 珋 ± s t 34 logistic P < PaO 2 PaCO 2 SaO 2 alanine aminotransferase ALT aspartate aminotransferase AST 24 h / ph ph 1 HCO - 3 prothrombin time 17 P < PT activated partial ALT thromboplastin time APTT < P < Glasgow coma scale GCS 21 P < PaO 2 / FiO 2

3 123 1 % % % % % % % % % % % % % % % % % % % % % % x 珋 ± s /min mmol /L g /L % ± ± ± ± ± ± ± ± ± ± ± ± ± ± t P SaO 2 % ph HCO - 3 APTT s g /L 10 9 /L 10 9 /L ± ± ± ± ± ± ± ± ± ± ± ± ± ± t P GCS mmol /L mmol /L ALT U /L PaO ± ± ± ± ± ± ± ± ± ± ± ± ± ± t P PT /min g /L /L % s ± ± ± ± ± ± ± ± ± ± ± ± ± ± t P AST U /L mmol /L 24 h ml PaCO ± ± ± ± ± ± ± ± ± ± ± ± t P mmhg = kpa APTT GCS ALT PT AST

4 124 SaO 2 PaO 2 /FiO 2 APACHE Ⅱ 1 ph ph logistic α in = α out = HCO - 3 ph β = = P = APTT OR = OR 95% CI ~ log ey / 1 - Y = a = PaO 2 /FiO 2 ph 2 = AST P = ph APACHEⅡ 1 APACHE Ⅱ 18 PaO 2 /FiO 2 PaO 2 /FiO 2 ph APACHEⅡ ALT μmol /L μmol /L 9 APACHEⅡ ~ APACHEⅡ ~ APACHE Ⅲ 7 ~ 8 30 ALT 3 5 ~ /L /L APACHE Ⅲ 2 27 g /L ~ 33 g /L 25% ALT HELLP AST 50% 4. 5 g /L 3 g /L 10 ALT APACHEⅡ 1. APACHE GCS Logistic 1

5 ~ ~ ~ ~ ~ ~ 41 < ~ ~ ~ ~ 160 < /min 12 ~ ~ ~ 35 6 ~ ~ 50 < /min 70 ~ ~ ~ ~ ~ < 40 5 ph ~ ~ ~ ~ ~ < Na + mmol /L 130 ~ ~ ~ ~ ~ ~ < K + mmol /L 3. 5 ~ ~ ~ ~ ~ < ~ < ~ ~ ~ ~ ~ ~ < /L 3 ~ ~ 40 1 ~ 3 40 < /L ~ ~ 50 < g /L ~ ~ 19 < mmol /L 3. 4 ~ ~ ~ 3. 4 < < ~ ~ ~ g /L 1. 5 ~ ~ ~ 1 < ALT U /L < ~ ~ PaO 2 /FiO ~ ~ ~ 175 < = 15 - GCS ALT 1 mmhg = kpa 4 GCS ALT APACHEⅡ APACHEⅢ APACHE APACHE Ⅱ APACHE Ⅲ

6 ~ 4 ALT 3 15 GCS GCS 15 1 Knaus WA Draper EA Wagner DP et al. APACHE II a Knaus WA Wagner DP Draper EA et al. ill hospitalized adults. Chest APACHEⅡ log ey / 1 - Y = APACHEⅡ Afessa B Green B Delke I et al. ICU obstetric patients treated in an ICU. Chest APACHEⅡ APACHEⅡ 6 Martin SR Foley MR. Intensive care in obstetrics an evidence- logistic log ey / 1 - Y = based review. Am J Obstet Gynecol APACHEⅡ log ey / 1 - Y = score in maternal admissions to the intensive care unit APACHEⅡ Obstet Gynecol e13-e Schobel HP. ICU 24 h logistic log ey / 1 - Y = APACHEⅡ a = = P = severity of disease classification system. Crit Care Med The APACHE III prognostic system. Risk prediction of hospital mortality for critically el-solh AA Grant BJ. A comparison of severity of illness scoring systems for critically ill obstetric patients. Chest Systemic inflammatory response syndrome organ failure and outcome in critically ill Mirghani HM Hamed M Ezimokhai M et al. Pregnancy-related admissions to the intensive care unit. Int J Obstet Anesth Stevens TA Carroll MA Promecene PA et al. Utility of Acute Physiology Age and Chronic Health Evaluation APACHE III Am J. APACHEⅡ ICU Pregnancy-induced alterations in renal function. Kidney Blood Press Res Pelzer H Schwarz A Heimburger N. Determination of human thrombin-antithrombin III complex in plasma with an enzymelinked immunosorbent assay. Thromb Haemost Sternbach GL. The Glasgow coma scale. J Emerg Med Tang LC Kwok AC Wong AY et al. Critical care in obstetrical patients an eight-year review. Chin Med J Engl Crapo RO. Normal cardiopulmonary physiology during pregnancy. Clin Obstet Gynecol Dunlop W. Serial changes in renal haemodynamics during normal human pregnancy. Br J Obstet Gynaecol APACHEⅡ APACHEⅡ J /CD