慢性阻塞性肺疾病急性加重期患者不同预后预测评估工具的对比应用研究

发布时间：2019-01-27 12:06

【摘要】：目的比较BAP-65评分(BUN,altered mental status,pulse,and age),改良早期预警评分(Modify early warning sore,MEWS),英国国家早期预警评分(National early warning score,NEWS)和慢性呼吸系统早期预警评分(Chronic respiratory early warning score,CREWS)对普通病房慢性阻塞性肺疾病急性加重期(Acute exacerbations of chronic obstructive pulmonary disease,AECOPD)患者的预后预测价值。方法1.本研究采用方便抽样法,根据纳入排除标准选取呼吸内科普通病房249例AECOPD患者为研究对象。在入院时即开始对患者进行BAP-65评分、MEWS评分、NEWS评分和CREWS评分,并收集患者基本资料,追踪患者院内预后情况直至离院。2.比较AECOPD患者不同预后分组,包括死亡组和存活组、入住ICU组和普通病房组、机械通气组和非机械通气组、有创机械通气组和非有创机械通气组的BAP-65评分、MEWS评分、NEWS评分和CREWS评分。3.通过构建ROC曲线,分析和比较BAP-65评分、MEWS评分、NEWS评分和CREWS评分对AECOPD患者不同预后预测的效能。结果1.本研究最终共纳入AECOPD患者249例,其中男210例,女39例;年龄48~95(72.24±9.374)岁;患者院内死亡10例(4.0%),入住icu28例(11.2%),行机械通气64例(25.7%),行有创机械通气11例(4.4%)。2.死亡组和存活组、入住icu组和普通病房组、机械通气组和非机械通气组、有创机械通气组和非有创机械通气组的bap-65评分、mews评分、news评分和crews评分差异均有统计学意义(p0.05)。3.bap-65评分、mews评分、news评分、crews评分预测aecopd患者院内死亡的roc曲线下面积(auroc)分别为0.760(95%ci0.702~0.812),0.846(95%ci0.751~0.860),0.959(95%ci0.926~0.980)0.924,0.924(95%ci0.884~0.958);预测入住icu的auroc分别为0.711(95%ci0.622~0.750),0.753(95%ci0.695~0.806),0.831(95%ci0.771~0.877),0.830(95%ci0.778~0.875);预测行机械通气治疗的auroc分别为0.593(95%ci0.530~0.655),0.669(95%ci0.604~0.734),0.778(95%ci0.731~0.844),0.765(95%ci0.707~0.816);预测行有创机械通气治疗的auroc分别为0.770(95%ci0.598~0.728),0.797(95%ci0.737~0.849),0.888(95%ci0.903~0.970),0.910(95%ci0.867~0.942)。4.bap-65评分、mews评分、news评分、crews评分预测aecopd患者入住icu的auroc差异并无统计学意义(p0.05);但在预测院内死亡时,news评分的auroc优于bap-65评分(p0.05);在预测行机械通气和行有创机械通气时,crews评分和news评分的auroc优于bap-65评分和mews评分(p0.05)。结论虽bap-65评分是aecopd患者特定的预后预测工具,但bap-65评分内含有实验室指标,应用于普通病房患者的病情连续性监测存在一定局限性。且bap-65评分和mews评分应用于普通病房的预测效能普遍偏低,因此,它们并不适用于普通病房aecopd患者。此外,news评分和crews评分不仅整体预后预测效能优于bap-65评分和mews评分,且操作简单、实用。由此可知,NEWS评分和CREWS评分更适合于普通病房AECOPD患者的病情评估。
[Abstract]:Objective to compare the BAP-65 score (BUN,altered mental status,pulse,and age), improved early warning score (Modify early warning sore,MEWS), the British National early warning score (National early warning score,NEWS) and the chronic Respiratory early warning score (Chronic respiratory early warning score,). The prognostic value of CREWS in patients with acute exacerbation of chronic obstructive pulmonary disease (Acute exacerbations of chronic obstructive pulmonary disease,AECOPD) in general wards. Method 1. In this study, a convenient sampling method was used to select 249 patients with AECOPD in general ward of respiratory medicine according to exclusion criteria. BAP-65 score, MEWS score, NEWS score and CREWS score were performed on admission, and basic data were collected to track the prognosis until the patient left hospital. To compare the BAP-65 scores and MEWS scores of AECOPD patients with different prognostic groups, including death group and survival group, ICU group and general ward group, mechanical ventilation group and non-mechanical ventilation group, invasive mechanical ventilation group and non-invasive mechanical ventilation group. NEWS score and CREWS score. 3. ROC curve was constructed to analyze and compare the efficacy of BAP-65 score, MEWS score, NEWS score and CREWS score in predicting the different prognosis of AECOPD patients. Result 1. A total of 249 patients with AECOPD were included in this study, including 210 males and 39 females, aged 482.24 卤9.374 years. 10 cases (4.0%) died in hospital, 11 cases (11.2%) were admitted to icu28, 64 cases (25.7%) were treated with mechanical ventilation, 11 cases (4.4%) were treated with invasive mechanical ventilation. The bap-65 and mews scores of death group and survival group, icu group and general ward group, mechanical ventilation group and non-mechanical ventilation group, invasive mechanical ventilation group and non-invasive mechanical ventilation group; There were significant differences between news score and crews score (p0.05). The area under roc curve of 3.bap-65 score, mews score, news score and crews score were 0.760 (95%ci0.702~0.812), respectively. 0.846 (95%ci0.751~0.860), 0.959 (95%ci0.926~0.980) 0.924 ~ 0.924 (95%ci0.884~0.958); The predicted auroc of icu were 0.711 (95%ci0.622~0.750), 0.753 (95%ci0.695~0.806), 0.831 (95%ci0.771~0.877), 0.830 (95%ci0.778~0.875). The auroc predicted by mechanical ventilation therapy were 0.593 (95%ci0.530~0.655), 0.669 (95%ci0.604~0.734), 0.778 (95%ci0.731~0.844), 0.765 (95%ci0.707~0.816); Auroc was predicted to be 0.770 (95%ci0.598~0.728), 0.797 (95%ci0.737~0.849), 0.888 (95%ci0.903~0.970), 0.910 (95%ci0.867~0.942). Mews score, news score and crews score had no significant difference in predicting auroc of aecopd patients in icu (p0.05). However, the auroc of news score was better than that of bap-65 score in predicting hospital death, and the auroc score of crews and news score was superior to bap-65 score and mews score in predicting mechanical ventilation and invasive mechanical ventilation (p0.05). Conclusion although the bap-65 score is a specific prognostic tool for aecopd patients, the bap-65 score contains laboratory indicators, and there are some limitations in monitoring the disease continuity of patients in general wards. The predictive efficacy of bap-65 and mews scores in general wards is generally low, therefore, they are not suitable for aecopd patients in general wards. In addition, news score and crews score are not only superior to bap-65 score and mews score in predicting prognosis, but also simple and practical. Therefore, NEWS score and CREWS score are more suitable for the evaluation of AECOPD patients in general wards.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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