成人加護病房疾病嚴重度分數系統

Severity Scoring Systems in Adult Intensive Care Unit

王淑惠(Shu-Hui Wang)

《重症醫學雜誌》 10卷3期 (2009/09) Pp. 176-189

摘要

健保局及衛生署資料顯示，台灣加護病房床數及醫療費用均逐年急速增加中，全球花在重症醫療費用也日趨可觀。但是，仍經常有重症患者因無法及時入住重症病床，遭受轉院、候床之苦。新制評鑑條文明訂轉入加護病房前應有患者疾病嚴重度的評估，做爲轉入加護病房的依據。JCAHO在加護病房評鑑審查條文中亦明文規定重症病患轉入加護病房前應有以生理參數爲法礎之疾病嚴重度的評估。健保局病歷審查加護病房住院患者時也特別注重患者是否符合住加護病房之適應症，做爲給付加護病房費之依據。因此，製訂共通標準化之疾病嚴重度評估系統，讓重症患者轉入加護病房前有決策依據是重要的課題。
目前重症病患缺乏乙套依疾病嚴重度分數做爲轉入加護病房前嚴重度量化工具的評估，導致輕症入住或安寧癌末、生命末期無效醫療患者佔住重症病床。本篇報告介紹成人加護重症病房適用之嚴重度分數系統：急性生理和慢性健康評估系統(Acute Physiology and Chronic Health Evaluation; APACHE)，簡化的急性生理分數(simplified Acute Physiology Score; SAPS)和死亡機率模型(Mortality Probability Models; MPM)，同時依各不同疾病別之專一性評分系統評分，包括：外傷患者評分之TRISS、心臟手術患者評分之EuroSCORE、一般手術患者評分之POSSUM、神經內外科之昏迷指數、敗血症分期系統、急性呼吸衰竭之PaO2/FIO2等，做爲在檢傷分類重症患者轉入加護病房前之評估，這些評估分數可以做爲轉入或不適當轉入之客觀指標，有效分配重症醫療資源的使用。

關鍵字

成人加護病房 ； 嚴重度分數系統 ； 急性生理和慢性健康評估 ； 簡化的急性生理分數 ； 死亡機率模型

並列摘要

According to the Bureau of National Health Insurance and Department of Health, Executive Yuan, Taiwan data analysis, the adult intensive care beds and the cost of providing critical care services are annually increasing. This phenomenon is also developing in the whole world, even though, there still have more critically ill patients who could not admit into the ICU and must face to be transported. The Taiwan Joint Commission on Hospital Accreditation requests that patients should be assessed by the disease severity tool before ICU admission. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) also has proposed that patients' physiologic- based severity assessment should be recorded before entering to the ICU. The Bureau of National Health Insurance paying the health insurance expense is according to whether the patient is eligible to ICU admission criteria. Therefore, to draw a standard operation protocol by physiologic-based severity scoring system for ICU admission is an important issue.
Development of a prognostic scoring system for patients before ICU admission is deficient. It leads to a mild disease, a hospice terminal cancer stage or a medically futile patient, occupy the intensive care bed. Three most popular prognostic models including acute Physiology and Chronic Health Evaluation (APACHE), Simplified Acute Physiology Score (SAPS) and Mortality Probability Models (MPM), will be introduced. The individual specific disease scoring systems included TRISS for trauma, EuroSCORE for cardiac surgery, POSSUM for major surgery, OCS for neurological disease, sepsis stages for septic patients, and PAO2 F102 for respiratory failure, are also discussed. All of these scoring systems could quantify the patients' severity to be a decision guide for ICU admission, and effectively use of ICU resources.

並列關鍵字

Adult intensive care unit ； Severity scoring system ； APACHE ； SAPS ； MPM