改良早期预警评分在急性中毒患者预后预测中的价值  

Value of MEWS score in prognosis for patients with acute poisoning

作　　者：李萍[1] 方婷婷[1,2] 肖江琴[1] 王海燕[1] 

机构地区：[1]新疆维吾尔自治区人民医院,新疆乌鲁木齐830000 [2]石河子大学医学院护理系,新疆石河子832000

出　　处：《护士进修杂志》2016年第12期1075-1077,共3页Journal of Nurses Training

基　　金：新疆维吾尔自治区科技支撑项目(编号:201442115)

摘　　要：目的探讨改良早期预警评分(MEWS)在急性中毒患者预后预测中的价值。方法选取我院急诊科2013年3月-2015年6月收治的328例急性中毒危重患者为研究对象,进行前瞻性观察性研究,分别对其进行MEWS评分和APACHEⅡ评分,追踪患者30d预后,比较两种评分不同分数段危重患者预后的人数、构成比、存活组和死亡组的评分,并通过ROC曲线下面积比较两种评分系统预后预测的准确度。结果以死亡作为预测指标时,MEWS评分界值是4.5分,灵敏度94.8%,特异度90.7%,ROC曲线下面积AZ=0.980,阳性预测值68.75%,阴性预测值98.79%;APACHEⅡ评分界值是20.5分,灵敏度98.3%,特异度94.8%,ROC曲线下面积AZ=0.991,阳性预测值80.3%,阴性预测值99.6%,就预后预测而言,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,两者比较差异无统计学意义(P>0.05)。结论 MEWS评分和APACHEⅡ评分均能够有效地预测急性中毒患者的预后,但MEWS评分简单、实用,更适用于急诊患者。Objective To study the value of modified early warning score（MEWS）for assessing prognosis for patients with acute poisoning.Methods 328 cases of severe patients with acute poisoning hospitalized from March 2013 to June 2015 in emergency room of our hospital was selected for the prospective observational study.their MEWS score and acute physiology and chronic health evaluation II（APACHE II）score,tracked prognosis in 30 days was conducted respectively.The number and composition of prognosis in critically ill patients at two different scoring scores,survival group and death group score was measured and compared.The accuracy of prognosis prediction of the two scoring systems was compared by the area under the ROC curve.Results When chose the death as the forecast index,the cut-off of MEWS was 4.5,sensitivity 94.8%,specificity 90.7%,area of ROC curve：Az=0.980,＋PV=68.75%,-PV=98.79%,the cut-off of APACHEⅡ was 20.5,sensitivity was 98.3%,specificity was 94.8%,area of ROC curve：Az=0.991,＋PV=90.3%,-PV=99.6%,in terms of prognostic aspects：MEWS and APACHEⅡscore ware fairly,the area under the ROC curve were above 0.9.It had high resolution,but there was no significant difference between them（P 0.05）.Conclusion Both MEWS and APACHEⅡ score can effective predict prognosis of patients with acute poisoning,but MEWS score is simple,practical,so it is more suitable use in emergency department patients.

关 键 词：改良早期预警评分 急性生理与慢性健康状况评分Ⅱ 急性中毒 预后 护理 

分 类 号：R471[医药卫生—护理学] R459.7[医药卫生—临床医学]