MEWS評分和APACHEⅡ評分評估急危重病人轉歸的研究  

Value of MEWS score and APACHE II score in evaluation of critically ill patients

作　　者：何澄幫 蘇玲敏 王小鷗 周德鴻 HE Cheng Bang;SOU Leng Man;WANG Xiao Ou;CHAO Tak Hong(Department of A&E,Kiang Wu Hospital,Macao,China)

机构地区：[1]澳門鏡湖醫院急診科,中國

出　　处：《镜湖医学》2020年第2期5-7,15,共4页MEDICAL JOURNAL OF KIANG WU

摘　　要：目的比較MEWS評分和APACHEⅡ評分在急診搶救室危重病人轉歸評估中的使用價值。方法收集鏡湖醫院急診科搶救室於2018年4月~2018年9月收治入院的患者基本資料。根據患者進入急診搶救室時第1次生命體征,床旁血氣分析,化驗結果,分別進行APACHEⅡ評分和MEWS評分,追蹤記錄患者30天内的轉歸,比較兩種評分對病人預後及是否需要轉入ICU的評估中的使用價值。結果共153例患者,死亡組共24例,存活組共129例,其中死亡組的APACHEⅡ和MEWS評分平均值均明顯高於存活組,差異有統計學意義(P<0.05);APACHEⅡ13分時對死亡預測敏感度為87.5%,為最佳約登指數。MEWS 5分時對死亡的預測敏感度為75%,為最佳約登指數。APACHEⅡ評分對建議入ICU的預測ROC曲線下的面積為0.66,MEWS評分為0.62。結論APACHEⅡ評分對死亡的預測能力比MEWS評分好,在對病人是否應該收住ICU的預測能力上,APACHEⅡ評分優於MEWS評分,但統計學分析顯示兩種評分準確性均較低。Objective To compare the value of MEWS score and APACHE II score in the evaluation of critical ill patients’outcomes in resuscitation room.Methods The data of patients admitted to resuscitation room of A&E department of Kiang Wu Hospital from April 2018 to September 2018 were collected.Based on the first batch of vital signs,bedside blood gas analysis and laboratory result,APACHE II score and MEWS score were performed.By tracking the outcomes of patients within 30 days,the value of the two scores in evaluating the patient's prognosis and the recommendation of ICU transfer was compared.Results A total of 153 patients,24 in death group,129 in survival group were included in the study.The APACHE II and MEWS scores in death group were significantly higher than thatin survivalgroups(P<0.05).The APACHE II score of 13 had the best Yoden index at which mortality prediction was 87.5%.The MEWS score of 5 was the best Yoden index at which mortality prediction was 75%,The area under the ROC curve of APACHE II for the proposed ICU prediction curve was 0.66;the area under the ROC curve of MEWS for the proposed ICU prediction was 0.62.Conclusion The APACHE II score predicts mortality better than the MEWS score,and the APACHE II score of 13 is the best Yoden index for death.The MEWS score of 5 is the best Yoden index for death;APACHE II score is better than MEWS score in predicting ICU admission,but both scores are of moderate acuracy in statistical analysis.

关 键 词：急診搶救室 APACHEⅡ評分 MEWS評分 

分 类 号：R47[医药卫生—护理学]