3种预警评分预测慢性阻塞性肺疾病急性加重期患者预后价值比较  

Comparison among prognostic value of three early warning scores in predicting acute exacerbation of chronic obstructive pulmonary disease

作　　者：付道芳 徐治波[1] 陈红[1] 曾嘉涛[1] 杜月君 杨春梅 FU Daofang;XU Zhibo;CHEN Hong;ZENG Jiatao;DU Yuejun;YNG Chunmei(Department of respiration, Chengdu Second People's Hospital, Chengdu 610021,China)

机构地区：[1]成都市第二人民医院呼吸内科

出　　处：《现代仪器与医疗》2019年第2期70-73,77,共5页Modern Instruments & Medical Treatment

基　　金：四川省成都卫生局科学研究基金，编号：20140735;成都市科技局项目，项目编号：2015-HM01-00621-SF

摘　　要：目的:比较3种预警评分预测慢性阻塞性肺疾病急性加重期(AECOPD)患者预后的价值。方法:选取193例AECPOD患者,于入院时分别使用英国国家早期预警评分(NEWS)、CURB-65评分、急性生理与慢性健康(APACHE-Ⅱ)评分评价患者病情,并按照患者预后,将其分别纳入死亡组和存活组、入住ICU组和未入住ICU组、机械通气组和非机械通气组、有创机械通气组和非有创机械通气组,比较各组患者NEWS、CURB-65、APACHE-Ⅱ评分的差异,并运用受试者工作特征曲线(ROC)及曲线下面积(AUC),分析3种预警评分预测AECOPD患者预后的参考价值。结果:193例患者预后转归为死亡8例(4.42%),存活185例(95.85%);入住ICU22例(11.40%);行机械通气50例(25.91%),其中8例行有创机械通气(16.00%)。死亡组、入住ICU组、机械通气组、有创机械通气组入院时NEWS、CURB-65、APACHE-Ⅱ评分均分别高于存活组、未入住ICU组、非机械通气组、非有创机械通气组,差异有统计学意义(P<0.05)。APACHE-Ⅱ评分预测AECOPD患者死亡、入住ICU、机械通气、有创机械通气的AUC均高于NEWS评分、CURB-65评分,NEWS评分预测AECOPD患者预后的AUC均高于CURB-65评分。CURB-65评分预测AECOPD患者预后的AUC均在0.7以上。结论:NEWS、CURB-65、APACHE-Ⅱ评分均可为AECOPD患者预后的预测提供可靠参考,NEWS、CURB-65评分简便易行,而APACHE-Ⅱ评分则更为全面、客观,可根据临床实际情况合理选择。Objective: This study aimed to compare the prognostic value of three early warning scores in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: 193 patients with AECPOD were selected, and were all evaluated when admitted in hospital respectively by the national early warning score (NEWS), the CURB-65 score, acute physiology and chronic health evaluation (APACHE-Ⅱ), and divided into death group and survival group, ICU admission group and non-ICU admission group, mechanical ventilation group and non-mechanical ventilation group and invasive mechanical ventilation group and non- invasive mechanical ventilation group according to the prognosis of patients. The differences in the NEWS, CURB-65 score, APACHE-Ⅱscore among the groups of patients were compared, and the receiver operating curve (ROC) and area under curve (AUC) were used to analyse the reference value of three early warning scores in predicting the prognosis of patients with AECOPD. Results: The prognosis of 193 patients was classified as death in 8 cases (4.42%) and survival in 185 cases (95.85%). 22 cases (11.40%) were admitted to ICU. Mechanical ventilation was performed in 50 cases (25.91%), among which 8 cases were invasive mechanical ventilation (16.00%). the NEWS, CURB-65 score, and APACHE-Ⅱscore in groups of death, ICU admission, mechanical ventilation, invasive mechanical ventilation were all higher than those in the groups of survival, non-ICU admission, mechanical ventilation, and non invasive mechanical ventilation, the difference was statistically significant (P<0.05). The AUC scores of APACHE-Ⅱscore predicting the death, ICU admission, mechanical ventilation, invasive mechanical ventilation of AECOPD patients were all higher than those of NEWS score and CURB-65 score, the AUC of NEWS score in predicting the prognosis of patients with AECOPD were higher than that of CURB-65 score. The AUC of CURB-65 score in predicting the prognosis of AECOPD patients were all above 0.7. Conclusions: The NEWS, C

关 键 词：预警评分 慢性阻塞性肺疾病急性加重期 预后 预测 

分 类 号：R563[医药卫生—呼吸系统]