SMART-COP评分在急诊科社区获得性肺炎需要机械通气的预测价值  

Predictive value of SMART-COP for the requirement of mechanical ventilation in patients with community-acquired pneumonia in emergency department

作　　者：苏鸿[1] 魏树全[1] 赵子文[1] 卢建华[1] 赵祝香[1] 

机构地区：[1]广州医科大学附属广州市第一人民医院急诊科,广州510180

出　　处：《新医学》2017年第4期245-249,共5页Journal of New Medicine

基　　金：广东省医学科学技术研究基金(A2015385)

摘　　要：目的探讨SMART-COP评分和CURB-65评分在急诊科社区获得性肺炎(CAP)患者需要机械通气的预测价值。方法采用前瞻性、观察性的研究方法,对住院急诊成年CAP患者进行SMART-COP评分、CURB-65评分,记录2种评分不同严重程度分层对应的需要机械通气的CAP患者数量及比例,绘制2种评分对预测CAP患者需要机械通气的受试者工作特征(ROC)曲线,比较其曲线下面积(AUC)。结果共502例住院急诊CAP患者纳入研究,其中11.2%的患者需要机械通气。SMART-COP评分≥3分和CURB-65评分≥3分预测CAP患者需要机械通气的灵敏度分别为98.2%和57.1%;2种量表预测CAP患者需要机械通气的ROC-AUC分别为0.918、0.798,比较差异有统计学意义(Z=6.619,P<0.001)。结论与CURB-65评分相比,SMART-COP评分对急诊科CAP患者需要机械通气有更高的预测价值。Objective To evaluate the predictive values of SMART-COP and CURB-65 scoring systems for the requirement of mechanical ventilation in patients diagnosed with community-acquired pneumonia （CAP） in the emergency department. Methods In this prospective observational study, the SMART-COP and CURB-65 scores of the hospitalized adult patients with CAP were calculated and assessed. The quantity and percentage of patients with different degree of CAP requiring mechanical ventilation were evaluated by the risk stratification analysis. The receiver operating characteristic （ROC） curves of the predictive values of two scoring systems were delineated and the areas under curve （AUC） were statistically compared. Results Among 502 enrolled CAP patients, 11.2% of them required mechanical ventilation. The sensitivity of a SMART-COP score≥3 and CURB-65 score ≥3 for predicting the requirement of mechanical ventilation in CAP patients was 98.2% and 57.1%, and the AUC was 0.918 and 0.798 for the SMART-COP and CURB-65 scoring systems with statistical significance （Z=6.619, P 〈 0.001）. Conclusion Compared with the CURB-65 scoring system, SMART-COP scoring system has better predictive values for the requirement of mechanical ventilation in the CAP patients admitted to the emergency department.

关 键 词：社区获得性肺炎 SMART-COP评分 CURB-65评分 急救 危重病 

分 类 号：R563.1[医药卫生—呼吸系统]