CREWS、BAP-65评分对急性加重期COPD患者是否需要机械通气治疗的预测效能  

Validation of CREWS and BAP-65 in predicting the need for mechanical ventilation of AECOPD patients

作　　者：黄文婷[1] 崔妙玲[1] 蒋云[1] 王自秀[1] 陆汪洋 柯斓[1] HUANG Wenting CUI Miaoling JIANG Yun WANG Zixiu LU Wangyang KE Lan(The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China)

机构地区：[1]广西医科大学第一附属医院,南宁530021

出　　处：《山东医药》2017年第7期20-22,共3页Shandong Medical Journal

基　　金：广西医疗卫生适宜技术开发与推广应用课题(S201665);广西急诊与医学救援人才小高地开放课题(GXJZ201427);广西医药卫生计划资助项目(Z2015513)

摘　　要：目的探讨慢性呼吸系统早期预警评分(CREWS)与BAP-65评分对普通住院病房慢性阻塞性肺疾病急性加重期(AECOPD)患者是否需要机械通气(MV)的预测效能。方法选择211例普通住院病房AECOPD患者,根据治疗过程中是否需要MV分为行MV者(观察组)和未行MV者(对照组)。于入院24 h内对211例纳入者进行CREWS、BAP-65评分,观察CREWS、BAP-65评分对AECOPD患者是否需要MV治疗的预测效能。结果观察组和对照组CREWS分别为(5.91±2.67)、(3.39±1.74)分,两组相比,P<0.05。观察组BAP-65评分等级为Ⅰ级7例、Ⅱ级19例、Ⅲ级15例、Ⅳ级4例、Ⅴ级0例,对照组分别为31、97、36、2、0例,两组相比,P<0.05。CREWS、BAP-65评分预测AECOPD患者是否需要MV的ROC曲线下面积(AUROC)分别为0.779与0.598。两种评分的AUROC分别与AUROC=0.5比较,P均<0.05。CREWS预测普通住院病房AECOPD患者行MV的AUROC明显高于BAP-65评分的AUROC,P<0.05。CREWS预测患者是否需要MV的最佳截断点为>5分,灵敏度为51.11%,特异度为86.75%;BAP-65评分预测患者是否需要MV的最佳截断点为>Ⅱ级,灵敏度为42.22%,特异度为77.11%。结论 CREWS、BAP-65评分均可用于预测普通住院病房AECOPD患者是否需要MV治疗,但CREWS对普通住院病房AECOPD患者是否需要MV的预测效能优于BAP-65评分。Objective To investigate the validation of chronic respiratory early warning score（ CREWS） and BAP-65 in predicting the need for mechanical ventilation（ MV） in acute exacerbations of chronic obstructive pulmonary disease（ AECOPD） patients in normal ward. Methods A total of 211 patients with AECOPD in normal ward were selected. According to the need for MV they were divided into MV group（ observation group） and non-MV group（ control group）.CREWS and BAP-65 were scored in 211 patients within 24 hours of admission. We built the ROC curve to analyze the performance of CREWS and BAP-65. Results The scores of CREWS in the observation group and control group were（ 5. 91± 2. 67） and（ 3. 39 ± 1. 74） points,and the differences were statistically significant（ P 〈 0. 05）. The grade of BAP-65 in observation group： there were 7 cases of gradeⅠ,19 cases of gradeⅡ,15 cases of gradeⅢ,4 cases of gradeⅣ and 0 of gradeⅤ,while they were 31,97,36,2 and 0 cases,respectively in the control group（ P 〈 0. 05）. The AUROC of CREWS and BAP-65 that predicted MV were 0. 779 and 0. 598,respectively,and the differences were statistically significant（ P 〈 0. 05）. AUROC of CREWS was significantly higher than that of BAP-65 in predicting the need for MV in AECOPD patients in normal ward（ P 〈 0. 05）. The cut-off points of CREWS were 〉 5,the sensitivity was 51. 11%,and the specificity was 86. 75%. The cut-off points of BAP-65 were 〉 Ⅱ grade,the sensitivity was 42. 22%,and the specificity was 77. 11%. Conclusion Both CREWS and BAP-65 can be used to predict the need for MV of AECOPD patients in normal ward,but the performance of CREWS is more accurate and suitable than that of BAP-65.

关 键 词：慢性阻塞性肺疾病 机械通气 慢性呼吸系统早期预警评分 BAP-65评分 

分 类 号：R473.5[医药卫生—护理学]