急救系统风险预测模型评分联合改良早期预警评分在多发伤危重症患者预后评估中的应用价值  

Application value of development and validation of risk-adjusted outcomes for systems of emergency medical care score combined with Modified Early Warning Score in the prognostic evaluation of critical patients with multiple injuries

作　　者：林建聪 洪蓉蓉[2] 黄国亮 罗毅[3] LIN Jian-cong;HONG Rong-rong;HUANG Guo-liang;Luo Yi(Department of Emergency,No.910 Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army,Quanzhou 362000,Fujian,China;Department of Outpatient,No.910 Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army,Quanzhou 362000,Fujian,China;Department of Emergency,Liuzhou Hospital of Traditional Chinese Medicine,Liuzhou 545001,Guangxi,China)

机构地区：[1]中国人民解放军联勤保障部队第910医院急诊科,福建省泉州市362000 [2]中国人民解放军联勤保障部队第910医院门诊部,福建省泉州市362000 [3]柳州市中医院急诊科,广西柳州市545001

出　　处：《广西医学》2022年第23期2740-2743,共4页Guangxi Medical Journal

摘　　要：目的探讨急救系统风险预测模型(DAVROS)评分联合改良早期预警评分(MEWS)对多发伤危重症患者预后的预测价值。方法选取1073例多发伤患者作为研究对象,根据入院后7 d患者的生存情况,将患者分为生存组和死亡组。比较两组患者的一般资料、初诊时的生理数据和血液检测数据、DAVROS评分、MEWS等指标。采用受试者工作特征(ROC)曲线比较DAVROS评分联合MEWS、MEWS对多发伤危重症患者预后的评估价值。结果相比于生存组,死亡组车祸致伤比例、原发损伤部位为头面颈部的比例、心率、呼吸频率和血钾、血尿素氮、血肌酐水平均更高,收缩压、体温、外周血氧饱和度、血小板计数、血红蛋白水平和格拉斯哥昏迷评分均更低(均P<0.05)。死亡组患者DAVROS评分和MEWS均高于生存组(均P<0.05);DAVROS评分联合MEWS、MEWS预测多发伤危重症患者入院后7 d死亡的曲线下面积分别为0.896、0.771,灵敏度分别为92.4%、70.3%,特异度分别为77.6%、74.6%。结论预后差的多发伤危重症患者的DAVROS评分更高。相比于单纯MEWS,DAVROS评分联合MEWS对多发伤危重症患者预后评估的准确性较高,可较为有效地预测患者入院后7 d的死亡情况。Objective To explore the predictive value of development and validation of risk-adjusted outcomes for systems of emergency medical care(DAVROS)score combined with Modified Early Warning Score(MEWS)on the prognosis of critical patients with multiple injuries.Methods A total of 1073 patients with multiple injuries were selected as the research subjects.The patients were divided into survival group or death group according to the survival status 7 days after admission.The indices of general data,newly diagnosed physiological data and blood test data,DAVROS score,and MEWS,etc.were compared between the two groups.The evaluated value of DAVROS score combined with MEWS,and MEWS on the prognosis of critical patients with multiple injuries was analyzed by the receiver operating characteristic(ROC)curve.Results Compared with the survival group,the death group exhibited higher proportions of injuries caused by car accidents,and of primary injuries to the head,face and neck,as well as higher heart rate,respiratory frequency,blood potassium level,blood urea nitrogen level,and blood creatinine level,and lower systolic blood pressure,body temperature,peripheral blood oxygen saturation,platelet counts,hemoglobin level,and Glasgow Coma Scale score(all P<0.05).The DAVROS score and MEWS in the death group were higher than those in the survival group(all P<0.05).The areas under the curve of DAVROS score combined with MEWS and MEWS on predicting 7-day post-admission mortality of critical patients with multiple injuries were 0.896 and 0.771,respectively,and the sensitivities were 92.4%and 70.3%,respectively,as well as the specificities were 77.6%and 74.6%,respectively.Conclusion Critical multiple injuries patients with poor prognosis obtain a higher DAVROS score.Compared with MEWS alone,DAVROS score combined with MEWS exerts a high accuracy on the prognostic evaluation in critical patients with multiple injuries,and can effectively predict the 7-day post-admission mortality status of patients.

关 键 词：急救系统风险预测模型 改良早期预警评分 多发伤 危重症 预后评估 

分 类 号：R641[医药卫生—外科学]