改良早期预警评分与急性生理和慢性健康状况对ICU创伤患者病情评价和预后预测的对比研究  

Modified early warning score and APACHE Ⅱ score in evaluating severity and predicting outcome of trauma patients at intensive care unit

作　　者：刘新平[1] 谢虹[2] 陶方萍[3] 

机构地区：[1]安徽省蚌埠医学院护理学系,233030 [2]山东省滨州市人民医院ICU [3]安徽省蚌埠医学院附属一院ICU

出　　处：《中国实用医刊》2011年第19期25-28,共4页Chinese Journal of Practical Medicine

摘　　要：目的比较改良早期预警评分（MEWS）和急性生理和慢性健康状况（APACHEⅡ）评分在ICU创伤患者病情评价和预后预测的可行性。方法回顾性分析综合ICU收治的190例创伤患者的临床资料。入ICU时即刻作为观察起点，通过查阅病历记录对每一例患者分别进行MEWS及APACHEⅡ评分，以经过治疗转出ICU为观察终点，资料收集完后进行统计分析。结果MEWS与APACHEⅡ评分分值段越高，病死率越高，各分值段比较差异有统计学意义（P〈0．01）；MEWS与APACHEⅡ评分与患者预后呈正相关，相关系数r值分别为0．441、0．525；以死亡为预测指标时，MEWS评分界值是4分，敏感度是88．1％，特异度是51．2％，其ROC曲线下面积AZ=0．763（95％ CI：0．693，0．832），P=0．000；APACHEⅡ评分界值是21分，敏感度是86．6％，特异度是54．5％，其ROC曲线下面积AZ=0．810（95％ CI：0．744，0．876），P=0．000。结论MEWS与APACHEⅡ评分均可判断ICU创伤患者病情严重程度，对其预后均具有中等程度预测价值，而MEWS操作简单快捷，费用低廉，可实现对患者快速动态的评估病情，更适用于ICU创伤患者。Objective To compare the feasibility of MEWS and APACHE H in evaluating severi- ty and predicting outcome of trauma patients at intensive care unit. Methods Retrospectively analysis of 190 cases of trauma patients admitted to ICU, through access to medical records for test as soon as they were hospitalized; Then we gave grade to every patient according to the APACHE Ⅱ and MEWS separate- ly; We finished the observation after treatment in ICU and took the prognosis as the observing index; Lastly we made the statistical analysis after the data collection. Results The higher the MEWS score and APACHE Ⅱ score segment, the higher the mortality rate was, there was statistically significant difference between segments （ P 〈0.01 ） ; The APACHE Ⅱ and MEWS had positive correlation with patients forecast, r was 0. 441, 0. 525. When choose the death as the forecast index. The cut - off of MEWS grade was 4. Sensitivity was 88. 1%, Specificity was 51.2% ; And area of ROC curve： Az = 0. 763 （95% CI ：0. 693,0. 832）. P = 0. 000. The cut - off of APACHE Ⅱ grade was 21, Sensitivity was 86.6% , Specificity was 54.5% ;and area of ROC curve： Az =0. 810（95% CI ：0. 744,0. 876）, P = 0. 000. Conclusions All of MEWS and APACHE Ⅱ score can be used to evaluate severity and have moderate predictive value of prognosis for ICU trauma patient. MEWS may be the first choice because of simplicity, affordable, allows dynamic assessment of patient＇ s condition compared with APACHE Ⅱ.

关 键 词：创伤 重症监护室 改良早期预警评分 急性生理和慢性健康状况评分 预后 

分 类 号：R563[医药卫生—呼吸系统]