国家早期预警评分联合动脉血乳酸在急诊老年危重症患者死亡预测中的意义  

The significance of national early warning score combined with arterial lactic acid detection in the prediction of death of critically ill elderly patients in emergency department

作　　者：张中明 杨静[1] 郝玉瑜[1] ZHANG Zhong-ming;YANG Jing;HAO Yu-yu(Emergency Department of Hefei First People's Hospital,Hefei 230061,China)

机构地区：[1]合肥市第一人民医院急诊内科,安徽合肥230061

出　　处：《武警后勤学院学报（医学版）》2018年第6期495-498,共4页Journal of Logistics University of PAP（Medical Sciences）

摘　　要：【目的】评价国家早期预警评分(national early warning score,NEWS)联合动脉血乳酸在急诊老年危重症患者死亡预测中的意义。【方法】2015年1月至2017年11月我院收治的450例老年危重症患者,采用NEWS评分、动脉血乳酸检测、NEWS评分联合动脉血乳酸检测对患者30 d的临床转归进行评价。【结果】450例患者30 d时均得到有效随访,存活326例(72.4%),死亡124例(27.6%)。患者NEWS评分以0～4分最多见,占40.0%,死亡率为13.9%。患者主要为低乳酸(<2 mmol/L),占56.2%,死亡率为15.4%。Logistic回归分析发现,NEWS评分(OR=2.348,95%CI:1.024～4.357,P=0.013)和动脉血乳酸水平(OR=2.674,95%CI:0.874～1.934,P=0.001)均为预测死亡的独立危险因素。联合检测的ROC曲线下面积为0.839,明显高于单独NEWS评分或动脉血乳酸检测的0.711、0.799,差异有统计学意义(P=0.012,P=0.035)。【结论】NEWS评分联合动脉血乳酸检测对预测急诊老年危重症患者死亡的价值较高,并且优于单独使用NEWS评分或动脉血乳酸检测。【Objective】To assess the significance of national early warning score(NEWS)combined with arterial lactic acid detection in the prediction of death of critically ill elderly patients in emergency department.【Methods】A total of 450 critically ill elderly patients in our hospital from January 2015 to November 2017 were included in this study.Clinical outcome was evaluated by the NEWS,arterial lactic acid detection or NEWS combined with arterial lactic acid detection in 30 days after admission.【Results】All the 450 patients were followed up effectively at 30 d,with 326(72.4%)cases of survival and 124(27.6%)cases of death.The NEWS of 0~4 was the most common in patients and accounted for 40%.The mortality rate was 13.9%.The patients were mainly in low lactic acid level(<2 mmol/L),accounting for 56.2%,and the mortality rate was 15.4%.Logistic regression analysis showed that the NEWS(OR=2.348,95%CI:1.024~4.357,P=0.013)and arterial lactic acid level(OR=2.674,95%CI:0.874~1.934,P=0.001)were independent risk factors in predicting death.The area under the ROC curve in the combined test was 0.839,which was significantly higher than that in the individual NEWS(0.711)or arterial lactic acid detection(0.799)(P=0.012,P=0.035).【Conclusion】The NEWS combined with arterial lactic acid detection is of a higher value in the prediction of death in critically ill elderly patients,and superior to the NEWS or arterial lactic acid detection.

关 键 词：国家早期预警评分 乳酸 老年 危重症 死亡 

分 类 号：R459.7[医药卫生—急诊医学]