MEWS评分评估急诊内科患者去向、预后的研究

发布时间：2018-05-20 00:29

  本文选题：MEWS + APACHE　； 参考：《新疆医科大学》2015年硕士论文

【摘要】：目的：评价改良早期预警评分(Modified early warning score, MEWS)预测急诊内科成人患者去向和预后的效力,探讨MEWS评分在临床应用的可行性,从而为急诊工作人员快速评估患者病情状况,合理分流、监护患者提供科学参考。方法：选取2014年1月至2014年3月期间在新疆某三级甲等医院急门诊内科就诊的成年患者为研究对象,进行前瞻性调查。记录急门诊内科就诊,符合纳入排除标准的研究对象入急诊时的首次体温、收缩压、心率、呼吸频率和意识状况,并进一步追踪患者的去向——是否入住急诊内科重症监护病房(Intensive care unit, ICU),出院时的预后状况——是否死亡,对入院24小时及以上,具有急性生理与慢性健康评价(Acute physiology and chronic health evaluation, APACHEⅡ)的患者记录其APACHEⅡ分值。根据患者的去向将患者分为急诊内科ICU组和非急诊内科ICU组,根据患者预后将患者分为死亡组、存活组,根据APACHEⅡ评分将患者病情划分为三个等级。利用受试者操作特征曲线下面积(The area under the receiver operating characteristic cure, AUROCC)评价MEWS评分的评估能力,根据约登指数确定MEWS评分的评价标准,通过筛检评价指标,灵敏度、特异度、阳性预测值、阴性预测值,符合率,对MEWS评分的判定结果进行分析。一般结果：1)总体情况：本研究共调查1000人,MEWS评分平均(3.24±2.05)分。其中共640人具有APACHEⅡ评分,APACHEⅡ评分平均(14.29±6.51)分；2)不同性别,不同民族急诊内科成年患者的MEWS评分之间比较差异不具有统计学意义(P0.05)；3)比较MEWS评分与增加年龄因素后的MEWS评分评估患者去向的AUROCC,两曲线下面积差异不具有统计学意义(P0.05)。比较MEWS评分与增加年龄因素后的MEWS评分预测患者预后的AUROCC,两曲线下面积差异不具有统计学意义(P0.05)；4)严重病组患者MEWS评分分值高于重病组患者,重病组患者的MEWS评分分值高于轻中病组,三组间MEWS评分分值差异具有统计学意义(P0.05)；5)MEWS评分与患者去向、预后、病情、APACHE II评分分值均呈正相关,相关系数分别为0.300、0.640、0.580、0.634；6)急诊内科ICU组患者MEWS评分分值高于非急诊内科ICU组,两组间差异具有统计学意义(P0.05),死亡组患者MEWS评分分值高于存活组,两组间差异具有统计学意义(P0.05)；7)MEWS评分评估患者去向的AUROCC为0.67,灵敏度是55.90%,特异度是71.80%,约登指数为0.28,阳性预测值54.90%,阴性预测值72.70%,符合率65.80%,MEWS评分评估患者去向的最佳截断值是4分,MEWS评分≥4分的患者病情严重；8)MEWS评分预测患者预后的AUROCC为0.96,灵敏度是95.50%,特异度是90.00%,约登指数为0.86,阳性预测值48.00%,阴性预测值99.50%,符合率90.50%,MEWS评分预测患者预后的最佳截断值是7分,MEWS评分≥7分的患者死亡风险大；9)比较MEWS评分与APACHEⅡ评分评估患者去向的AUROCC,差异不具有统计学意义(P0.05)。比较MEWS评分与APACHEⅡ评分预测患者预后的AUROCC,差异不具有统计学意义(P0.05)；10)将MEWS评分划分为0～3分、4～6分和7～14分三个分值段。分值段越高,患者的急诊内科ICU入住率越高,三个分值段之间急诊内科ICU入住率比较差异具有统计学意义(P0.05)。分值段越高,患者的死亡率越高,三个分值段之间患者死亡率比较差异具有统计学意义(P0.05)。结论：1) MEWS评分可用于评估不同性别、年龄、民族的急诊内科成年患者；2)MEWS评分可用于评估急诊内科患者的去向、预测患者预后,MEWS评分越高,患者的病情越严重,入住急诊内科ICU的风险越大,预后越差；3)MEWS评分评估急诊内科患者去向的最佳截断值是4分,预测急诊内科患者预后的最佳截断值是7分；4)MEWS评分与APACHEⅡ评分对急诊内科患者去向具有中等预测价值,APACHEⅡ评分的评价效力稍高。MEWS评分对急诊内科患者预后具有较高的预测价值,APACHEⅡ评分对急诊内科患者预后具有中等预测价值,MEWS评分的评价效力较局。
[Abstract]:Objective: To evaluate the effectiveness of the improved early warning score (Modified early warning score, MEWS) to predict the direction and prognosis of adult patients in emergency internal medicine, and to explore the feasibility of MEWS score in clinical application, so as to provide emergency staff with rapid assessment of patient's condition, reasonable flow of flow, and a scientific reference for monitoring patients. Method: 1 in 2014. During the period from month to March 2014, a prospective investigation was conducted in the medical department of a three grade three class a hospital. A prospective investigation was conducted. The medical treatment in the emergency clinic was recorded. The first body temperature, systolic pressure, heart rate, respiratory frequency and consciousness were observed in the emergency clinic. Whether or not to stay in the emergency internal medicine, Intensive care unit (ICU), the prognosis of the hospital at discharge - whether death, 24 hours to the hospital and above, patients with acute physiological and chronic health assessment (Acute physiology and chronic health evaluation, APACHE II) recorded their APACHE II scores. The patients were divided into the emergency internal medicine ICU group and the non emergency internal medicine ICU group. The patients were divided into the death group according to the prognosis of the patients. The survival group was divided into three grades according to the APACHE II score. The evaluation score was evaluated using the area under the subject operating characteristic curve (The area under the receiver operating characteristic cure, AUROCC). The evaluation criteria of the MEWS score were determined according to the Joseph's index. Through the screening evaluation index, sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate, the results of MEWS score were analyzed. General results: 1) the overall situation: This study investigated 1000 people, and the MEWS score was average (3.24 + 2.05). Among them, there were 640 people. With APACHE II score, APACHE II score was average (14.29 + 6.51); 2) there was no statistically significant difference between MEWS scores of adult patients in different nationalities (P0.05); 3) compared the MEWS score and the MEWS score after increasing age factors to evaluate the patient's AUROCC, and the difference in area under the two curve was not unified. Study significance (P0.05). Compared with the MEWS score after MEWS score and age increasing, the prognosis of patients was predicted by AUROCC, and the area difference under the two curve was not statistically significant (P0.05); 4) the score of MEWS score in the patients with severe disease was higher than that in the severe disease group, and the score of the MEWS score in the severe disease group was higher than that in the light medium disease group, and the score of the MEWS score was poor between the three groups. The difference had statistical significance (P0.05); 5) MEWS score was positively correlated with the patient's direction, prognosis, condition, APACHE II score score, the correlation coefficient was 0.300,0.640,0.580,0.634; 6) the score of MEWS score in group ICU patients was higher than that of non emergency internal medicine ICU group, the difference between the two groups was statistically significant (P0.05) and the MEWS score of the death group. The difference between the two groups was statistically significant (P0.05); 7) the MEWS score was 0.67, the sensitivity was 0.67, the sensitivity was 55.90%, the specificity was 71.80%, the index was 0.28, the positive predictive value was 54.90%, the negative predictive value was 72.70%, the coincidence rate was 65.80%, and the best cut-off value of the MEWS score was 4, MEWS score. The patients with more than 4 points were seriously ill; 8) the prognosis of the patients with MEWS score was 0.96, the sensitivity was 95.50%, the specificity was 90%, the ratio was 0.86, the positive predictive value was 48%, the negative predictive value was 99.50%, the coincidence rate was 90.50%, the best cut-off value of the prognosis of the patient was 7, the MEWS score was greater than 7, and 9) was higher than that of 0.96. 9) ratio The difference between the MEWS score and the APACHE II score was not statistically significant (P0.05). The difference between the MEWS score and the APACHE II score for predicting the prognosis of the patients was not statistically significant (P0.05); 10) the MEWS score was divided into 0~3 points, 4~6 points and 7~14 points, and three segments. The higher the score, the patient's urgency was higher. The higher the occupancy rate of ICU in the medical department, the difference of ICU occupancy rate in the emergency internal medicine between the three segments was statistically significant (P0.05). The higher the score segment, the higher the mortality rate, the difference between the three segments of the patients was statistically significant (P0.05). Conclusion: 1) the MEWS score could be used to assess the gender, age, and nationality. Emergency internal medicine adult patients; 2) MEWS score can be used to assess the direction of patients in the emergency internal medicine, predict the patient's prognosis, the higher the MEWS score, the more serious the patient's condition, the greater the risk of ICU, the worse the prognosis; the best truncation value of the MEWS score is 4, and the prognosis of the patient is the most. The good truncation value is 7 points; 4) MEWS score and APACHE II score have medium predictive value for patients in the emergency internal medicine. The evaluation effect of APACHE II score is slightly higher than that of.MEWS score, which has a high predictive value for the prognosis of the patients in the emergency internal medicine. The APACHE II score has a moderate predictive value for the prognosis of the patients and the evaluation effect of the MEWS score. Compared to the Bureau.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R472.2
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本文编号：1912386