MEWS评分和APACHEⅡ评分对急诊老年危重症患者预后的评估效果分析  

MEWS Score and APACHEⅡ Score in Prognosis Evaluation of the Critical Elderly of Emergency

作　　者：刘京鹤[1] 马剡芳[1] 常宇飞[1] Liu Jinghe;Ma Shanfang;Chang Yufei(Department of Emergency,Beijing Ditan Hospital Capital Medical University,Beijing,100015,P.R.China)

机构地区：[1]首都医科大学附属北京地坛医院,北京100015

出　　处：《老年医学与保健》2018年第3期315-318,共4页Geriatrics & Health Care

摘　　要：目的探讨改良早期预警(MEWS)评分和急性生理与慢性健康状况评估(APACHEII)评分对急诊老年危重症患者预后的评估效果。方法选取2016年8月—2017年10月来我院急诊科收治的360例老年危重症患者为研究对象,分别用MEWS评分和APACHEII评分对患者进行评估,分析2种评分手段不同分值与患者死亡率之间的关系,以及死亡组和存活组所得分值的差别;同时分析2种评分手段下受试者工作特征曲线(ROS)下面积,比较不同评分手段对急诊老年危重患者预后评估的准确性。结果急诊老年危重患者的死亡率随着MEWS评分和APACHEII评分分值升高而增加,差异有统计学意义(P<0.05);MEWS评分的ROS曲线下面积为0.776,显著低于APACHEⅡ评分的0.848(P<0.05);死亡组患者的MEWS评分和APACHEII评分显著低于生存组(P<0.05)。结论 MEWS评分和APACHEⅡ评分均能初步对急诊老年危重症患者的预后进行评估,MEWS评分手段使用方便和成本低,但其判断预后的准确性相对较低;APACHEⅡ评分手段使用复杂和成本高,但其判断预后的准确性相对较高。同时运用MEWS评分和APACHEⅡ评分对急诊老年危重症患者预后进行评估,效果更佳。Objective To discuss the effect of modified early warning score（MEWS） and acute physiology and chronic health evaluation（APACHEⅡ） score in evaluating the prognosis of the critical elderly of emergency. Methods 360 critical elderly of emergency during the period from Aug., 2016 to Oct., 2017 were enrolled; NEWS and APACHEⅡ score were applied in the evaluation respectively; the values of different grades in the 2 scoring and their correlaton with mortality were analyzed as well as the value difference between mortality and survival; the difference in area under receiver operating characteristic curve（AUROCC） between MEWS and APACHE II score was studied, and the evaluation accuracy of the 2 scoring were compared.Results The mortality in critical elderly of emergency went up with the value increase of the 2 scoring, the difference among each value grade was of statistical significance（P 0.05）; AUROCC of MEWS was 0.776, much lower than that of APACHEⅡ score（0.848）（ P0.05）; MEWS and APACHEⅡ score in death group were much lower than those in survival group（ P0.05）.Conclusions MEWS and APACHEII score can evaluate the prognosis of critical elderly of emergency; MEWS is of easy operation and low cost but with a relatively lower accuracy while APACHEⅡ score is of complicated operation and high cost but with a relatively higher accuracy; a better evaluation effect may be gained through the combined application of MEWS and APACHEⅡ score.

关 键 词：老年 急诊 危重症患者 MEWS评分 APACHEII评分 预后 评估 

分 类 号：R459.7[医药卫生—急诊医学]