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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/20 16:30:03」(JST)

APACHE II ("Acute Physiology and Chronic Health Evaluation II") is a severity-of-disease classification system (Knaus et al., 1985),^[1] one of several ICU scoring systems. It is applied within 24 hours of admission of a patient to an intensive care unit (ICU): an integer score from 0 to 71 is computed based on several measurements; higher scores correspond to more severe disease and a higher risk of death. The first APACHE model was presented by Knaus et al in 1981.^[2]

Application

APACHE II was designed to measure the severity of disease for adult patients admitted to intensive care units. It has not been validated for use in children or young people aged under 16.

This scoring system is used in many ways which include:

Some procedures or some medicine is only given to patients with a certain APACHE II score
APACHE II score can be used to describe the morbidity of a patient when comparing the outcome with other patients.
Predicted mortalities are averaged for groups of patients in order to specify the group's morbidity.

Even though newer scoring systems, such as SAPS II, have replaced APACHE II in many places, APACHE II continues to be used extensively because so much documentation is based on it.^{[citation needed]}

Calculation

The point score is calculated from a patient's age and 12 routine physiological measurements:

AaDO2 or PaO2 (depending on FiO2)
Temperature (rectal)
Mean arterial pressure
pH arterial
Heart rate
Respiratory rate
Sodium (serum)
Potassium (serum)
Creatinine
Hematocrit
White blood cell count
Glasgow Coma Scale

These were measured during the first 24 hours after admission, information about previous health status, and some information obtained at admission (such as age). The calculation method is optimized for paper schemas, by using integer values and reducing the number of options so that data fits on a single-sheet paper form.

The score is not recalculated during the stay; it is by definition an admission score. If a patient is discharged from the ICU and readmitted, a new APACHE II score is calculated.

In the original research paper that described the APACHE II score (see references), patient prognosis (specifically, predicted mortality) was computed based on the patient's APACHE II score in combination with the principal diagnosis at admission.^[3]

APACHE III

A method to compute a refined score known as APACHE III was published in 1991.^[4]

The score was validated on the dataset from 17,440 adult medical/surgical intensive care unit (ICU) admissions at 40 US hospitals.

The prognostic system of APACHE III has two options:

1. APACHE III Score

This provides an initial risk classification of severely ill hospitalized patients in defined groups.

2. APACHE III predictive equation

This uses APACHE III Score with a number of additional variables including the primary reason for ICU admission (from a reference list of 212 conditions classified according to etiology, major organ involved, and distinction between surgical/medical categories); age, sex, race and preexisting comorbidities; and location prior to ICU admission (operating room, recovery or emergency room, transfer or readmission from another hospital or ICU).

When possible, data about the interval time between the patient´s arrival to hospital and the ICU admission time are collected.

To measure severity of disease 20 physiologic variable were selected.

APACHE III scores range from 0 to 299.^[4]

Reformulated Glasgow Coma parameters to eliminate almost identical scores for different neurological signs would give better and more reliable results.

References

^ Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985). "APACHE II: a severity of disease classification system". Critical Care Medicine 13 (10): 818–29. doi:10.1097/00003246-198510000-00009. PMID 3928249. (This is the first published description of the APACHE II scoring system)
^ Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE (1981). "APACHE-acute physiology and chronic health evaluation: a physiologically based classification system.". Critical Care Medicine 9 (8): 591–7. doi:10.1097/00003246-198108000-00008. PMID 7261642.
^ Knaus WA, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818-29.
^ ^a ^b Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A et al. (1991). "The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults". Chest 100 (6): 1619–36. doi:10.1378/chest.100.6.1619. PMID 1959406. .

External links

Microsoft Excel function to calculate APACHE II score
Commonly used website to calculate APACHE II score with visual representation of predicted mortality

UpToDate Contents

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English Journal

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Japanese Journal

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Related Pictures

★リンクテーブル★

拡張検索	「APACHEIIスコアリングシステム」「APACHE system」「APACHE II score」「APACHE II scoring system」
関連記事	「apache」

「APACHEIIスコアリングシステム」

　　[★]

英: APACHE II scoring system
関: APACHE system

APACHEスコアリングシステムは、ICU患者の病態の重傷度を客観的に評価する目的で開発された。
このシステムは熱傷患者や人工心肺後の患者を想定したものではない。
個々のICU患者の死亡率を予測する能力には限界があるが、臨床研究において対象患者の疾患重症度を定量化する目的で広く利用されている。
1. 急性生理スコア Acute Physiology Score APS

ICU入室後24時間以内に得られた12種類の臨床検査の測定値。(何度か測定した検査結果のうち？)もっとも異常な値を選択しスコアを決定。行わなかった検査は0点

2. 年齢による調整
3. 慢性疾患による調整

http://www.osaka-med.ac.jp/deps/emm/apache2.pdf

「APACHE system」

　　[★]

同: Acute Physiology and Chronic Health Evaluation APACHE
関: APACHEIIスコアリングシステム

「APACHE II score」

　　[★] APACHEIIスコアリングシステム

「APACHE II scoring system」

　　[★] APACHEIIスコアリングシステム

「apache」

　　[★]

概念

Webサーバソフトウェアの一つ

linux

CentOSなどは以下の場所にあるらしい

/etc/httpd/conf/httpd.conf

サービスの状態確認・起動・停止

/etc/init.d/httpd status
/etc/init.d/httpd restart
/etc/init.d/httpd start
/etc/init.d/httpd stop

windows

サービスとして登録するにはどうすれば良いか

httpd.exe -k instal

設定

ディレクトリ一覧不可にする

http://d.hatena.ne.jp/catseye88/20071127/1196127803

[pmid3928249-1] Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985). "APACHE II: a severity of disease classification system". Critical Care Medicine 13 (10): 818–29. doi:10.1097/00003246-198510000-00009. PMID 3928249. (This is the first published description of the APACHE II scoring system)

[pmid7261642-2] Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE (1981). "APACHE-acute physiology and chronic health evaluation: a physiologically based classification system.". Critical Care Medicine 9 (8): 591–7. doi:10.1097/00003246-198108000-00008. PMID 7261642.

[3] Knaus WA, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818-29.

[pmid1959406-4] Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A et al. (1991). "The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults". Chest 100 (6): 1619–36. doi:10.1378/chest.100.6.1619. PMID 1959406. .

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APACHE