MEWS与APACHEⅡ评分在急诊潜在危重病患者病情评价和预后预测中的对比研究  

COMPARISON OF MODIFIED EARLY WARNING SCORE(MEWS) AND APACHE Ⅱ SCORE IN EVALUATION SEVERITY AND PREDICTION OUTCOME OF EMERGENCY POTENTIAL SEVERITY DISEASE

作　　者：孟新科[1] 杨径[1] 吴华雄[1] 朱虹[1] 郑晓英[1] 魏刚[1] 刘德红[1] 苏顺庭[1] 

机构地区：[1]广东省深圳市第二人民医院急诊科,广东深圳518035

出　　处：《实用临床医药杂志》2005年第8期1-4,共4页Journal of Clinical Medicine in Practice

基　　金：广东省深圳市科技计划项目(200304086)

摘　　要：目的比较APACHEⅡ和MEWS评分在急诊潜在危重病病情评价和预后预测中的适用性和可行性。方法分别对急诊科留观察和抢救室的501例患者进行APACHEⅡ和MEWS评分,追踪所有患者的去向和预后。分别比较APACHEⅡ和MEWS评分不同分数段患者收住ICU、HDU、门诊治疗的构成比;死亡、1月以内出院、门诊治疗后痊愈的构成比;比较A-PACHEⅡ和MEWS评分对患者病情评价和预测预后分辨度的ROC曲线差异。结果MEWS评分5分以上,危重患者的构成比明显增加,与5分以下相比差异显著(P<0.05)。MEWS评分5分以上对危重患者(需要收住ICU)鉴别的灵敏度为100%,特异度为81.5%;对需要收专科病房治疗患者鉴别的灵敏度为84.3%,特异度为88.3%。APACHEⅡ评分15分以上,危重患者的构成比明显增加,与15分以下相比,差异显著(P<0.05)。APACHEⅡ评分15分以上对危重患者(需要收住ICU)鉴别的灵敏度为89.2%,特异度为96.3%;APACHEⅡ评分10分以上对需要收专科病房治疗患者鉴别的灵敏度为94.3%,特异度为82.3%。就患者是否收住ICU或患者病死危险性的预测和评估的鉴别能力而言,MEWS和APACHEⅡ评分两者相当,其ROC曲线下面积均在0.90以上,具有较高的分辨能力,但两者间无显著差异(P>0.05);而在是否收住专科病房的鉴别能力上,APACHEⅡ评分显著高于MEWS(P<0.05)。结论APACHEⅡ评分和MEWS评分均可用于判断急诊患者的病情严重程度,有一定的识别“急诊潜在危重病”的能力。而MEWS评分因快速、简捷、费用低廉和便于操作,更适用于急诊科。Objective To compare the applicability and practicability of MEWS and A- PACHE Ⅱ in evaluating severity and predicting outcome of emergency potential severity disease. Methods Dada of all 501patients in emergency observation ward and rescue room were recorded and scored with MEWS and APACHE Ⅱ score respectively. Main outcome measures were cardiac arrest and CPCR, intensive care unit （ICU） admission, high dependency unit （HDU） admission, outpatient ; death , hospital discharge in 3 0 days . Ratio of patients in deferent score segments for these indexes were compared respectively as well as area under of ROC curve of MEWS and APACHE Ⅱ score in some of these indexes . Results A ScoreMax of 5 or more was associated with an increase risk of death, ICU admission and HDU admission for MEWS. Ratio of severity patients in score of 5 or more was significantly higher than that of score of less to 5 （ P 〈 0.05）. The sensitivity was 100 % and specificity was 81.5 % when 5 of MEWS were used to discriminate the ICU admission of patients; the sensitivity was 84.3% and specificity was 88.3% for HDU admission. A Score Max of 15 or more was associated with an increase risk of death, ICU admission and HDU admission for APACHE Ⅱ score. Ratio of severity patients in score of 15 or more was significantly higher than that of score of less than 15 （ P 〈 0.05 ）. The sensitivity was 89.2% and specificity was 96.3% when 15 of APACHE H score were used to discriminate the ICU admission of patients; the sensitivity was 94.3 % and specificity was 82.3 % for HDU admission at 10 of APACHE Ⅱ score. In discriminating the ICU admission and death risk of patients, MEWS had considerable power compared with APACHE H score （ P 〉 0.05 ）. All of MEWS and APACHE Ⅱ had good discriminating power for ICU admission and death risk of patients. APACHE Ⅱ had better power in discriminating HDU admission compared with MEWS （ P 〈0.05）. Conclusion All of MEWS and APACHE H can be used to evaluate severity of emergency pati

关 键 词：APACHEⅡ MEWS 急诊潜在危重病 病情 预后 

分 类 号：R459.7[医药卫生—急诊医学]