APACHE II 评分APACHE II Score

急性生理与慢性健康评估 · 入ICU 24小时内最差值Acute Physiology & Chronic Health Evaluation · worst value in first 24h of ICU admission

1基本信息Basic Info

年龄（岁）Age (years)

2急性生理评分（12项）Acute Physiology Score (12 variables)

体温（直肠/核心温度 °C）Temperature - rectal/core (°C)

平均动脉压 MAP（mmHg）Mean Arterial Pressure (mmHg)

MAP = (SBP + 2×DBP) / 3

心率（次/分）Heart Rate (bpm)

呼吸频率（次/分）Respiratory Rate (breaths/min)

氧合状态Oxygenation

FiO₂ ≥ 50% 时按 A-aDO₂ 计分，需要 PaCO₂ 计算肺泡气方程When FiO2 ≥ 50%, score by A-aDO2; PaCO2 needed for alveolar gas equation

FiO₂ < 50% 时仅需 PaO₂ 计分When FiO2 < 50%, score by PaO2 alone

酸碱状态Acid-base status

动脉血气 pHArterial pH

无ABG，用血清HCO₃⁻No ABG, use serum HCO3

血钠（mmol/L）Sodium (mmol/L)

血钾（mmol/L）Potassium (mmol/L)

血肌酐（mg/dL）Creatinine (mg/dL)

1 mg/dL = 88.4 µmol/L

急性肾衰竭（分值加倍）Acute renal failure (double points)

红细胞压积 Hct（%）Hematocrit (%)

白细胞（×10⁹/L）WBC (×10⁹/L)

格拉斯哥昏迷评分 GCS（3–15）Glasgow Coma Scale (3–15)

镇静/肌松患者建议使用镇静前GCS；若无法获得可靠的镇静前评分，记为15分If sedated/paralyzed, use pre-sedation GCS; if unavailable, score as normal (GCS=15)

3慢性健康评分Chronic Health Points

以下5类须在本次患病/手术前即已存在。满足任意一类即触发加分（不叠加，只看是否≥1类符合） Any of the 5 categories below must predate this illness/surgery. Meeting ANY ONE triggers the points (not additive — only whether ≥1 applies)

肝：活检证实肝硬化合并门脉高压；既往因门脉高压导致上消化道出血；既往肝功能衰竭/肝性脑病/肝昏迷发作 Liver: biopsy-proven cirrhosis with portal hypertension; prior UGI bleeding from portal HTN; prior hepatic failure/encephalopathy/coma

心血管：NYHA IV级心功能不全 Cardiovascular: NYHA Class IV

呼吸：慢性限制性/阻塞性/血管性肺病致严重活动受限（不能爬楼或不能做家务）；或慢性缺氧、高碳酸血症、继发性红细胞增多症、重度肺动脉高压(>40mmHg)、呼吸机依赖 Respiratory: chronic restrictive/obstructive/vascular disease with severe exercise restriction; or documented chronic hypoxia, hypercapnia, secondary polycythemia, severe pulmonary HTN (>40mmHg), or ventilator dependency

肾：长期透析 Renal: chronic dialysis

免疫抑制：免疫抑制治疗/化疗/放疗/长期或近期大剂量激素；或疾病本身已使易感染性显著增加（如白血病、淋巴瘤、AIDS） Immunocompromised: immunosuppressive therapy, chemo, radiation, long-term/recent high-dose steroids; or disease advanced enough to suppress infection resistance (e.g. leukemia, lymphoma, AIDS)

入院/手术情况Admission / surgical status

非手术 / 急诊术后（+5）Nonop / emergency postop (+5)

择期术后（+2）Elective postop (+2)

APACHE II 总分Total APACHE II Score

低危Low risk

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生理分APS 0 年龄分Age 0 慢性病分Chronic 0

分数段Score	0–9	10–19	20–24	25–29	30–34	≥35
预估死亡率Est. mortality	<10%	15–25%	~40%	~55%	~73%	>85%

*为未按疾病诊断类别校正的人群总体参考区间（Knaus et al. 1985）。精确预测死亡率需结合具体入科诊断权重及是否急诊手术，本工具不做该项计算，仅供严重程度分级参考。评分结果不能替代临床判断。 *General population reference range, NOT adjusted for admission diagnosis category (Knaus et al. 1985). Precise mortality prediction requires diagnosis-specific weighting and emergency-surgery status, which this tool does not compute. For severity stratification reference only — not a substitute for clinical judgment.