临终病情评估单预测临终患者生存期的效果  

Efficacy of terminal patient condition assessment form in predicting survival time of terminal patients

作　　者：蔡强 单悌超[2] 吴晗 CAI Qiang;SHAN Tichao;WU Han(Department of General Internal Medicine,Shandong Electric Power Central Hospital,Jinan 250001,Shandong,China;Department of Critical Medicine,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China;Department of Geriatric Medicine,Shandong Electric Power Central Hospital,Jinan 250001,Shandong,China)

机构地区：[1]山东电力中心医院普通内科,山东济南250001 [2]山东大学齐鲁医院重症医学科,山东济南250012 [3]山东电力中心医院老年病科,山东济南250001

出　　处：《山东大学学报（医学版）》2023年第5期79-83,共5页Journal of Shandong University:Health Sciences

摘　　要：目的 评价临终患者病情评估单预测临终患者生存期的效果。方法 回顾性分析2020年4月至2022年2月山东电力中心医院老年病区死亡的26例临终患者的临床资料。计算预期生存时间与实际生存时间的符合率、预测生存时间少于30 d的评分界值的合理性。绘制生存曲线并探讨各评估因素对生存时间的影响。采用临终病情评估单对生命体征等指标进行评分,各项指标综合得出综合性得分,分析与生存期的关联。结果 入院时评估的符合率65.38%。部分评估项目设有警示指标,多个警示指标预测生存期不足3 d的符合率100%。最常见的警示指标:意识状态的改变(76.92%),收缩压<80 mmHg(38.46%),呼吸>30次/min(26.92%)。50分作为预测生存时间少于30 d界限值的灵敏度为77.78%,特异度为83.33%,阳性预测值93.33%,阴性预测值55.55%,约登指数为0.61。评分在50分及以下组、评分在50分以上组生存时间存在着统计学差异(P=0.021)。Cox分析显示:临终病情评估单评分呼吸(HR=0.609,95%CI:0.381~0.973)、脉搏(HR=0.615,95%CI:0.426~0.889)、脏器状况(HR=0.362,95%CI:0.170~0.773)对生存时间的影响具有统计学意义(P<0.05)。结论 临终患者病情评估单能够比较准确地评估晚期癌症、慢性器官衰竭、失智等临终患者的生存期。Objective To evaluate the efficacy of Terminal Patient Condition Assessment Form in predicting the surviv-al time of terminal patients.Methods Clinical data of 26 terminal patients admitted to the geriatric ward of Shandong Electric Power Central Hospital during Apr.2020 and Feb.2022 were retrospectively analyzed.The match rate between predicted and actual survival time was calculated,and the rationality of score threshold for predicting survival time less than 30 d was determined.The survival curve was drawn and the influence of each predicting factor on survival time was investigated.The vital signs and other indicators were scored with the Terminal Patient Condition Assessment Form,the total scores were obtained,and the correlation between the scores and survival time was analyzed.Results The match rate of assessment at admission was 65.38%.Some predicting items included warning indicators.The match rate of warning indicators in predicting survival time less than 3 d was 100%.The most common warning indicators were the changes of consciousness(76.92%),systolic blood pressure<80 mmHg(38.46%),and respiratory rate>30/min(26.92%).The sensitivity and specificity of 50 points as score threshold for predicting survival time less than 30 d were 77.78%and 83.33%,respectively;the positive and negative predictive value were 93.33%and 55.55%,respectively;the Youden index was 0.61.There was significant difference in survival time between the group with score≤50 points and group with score>50 points(P=0.021).Cox analysis showed scores of respiratory(HR=0.609,95%CI:0.381-0.973),pulse(HR=0.615,95%CI:0.426-0.889)and organ status(HR=0.362,95%CI:0.170-0.773)had signifi-cant effects on survival time(P<0.05).Conclusion Terminal Patient Condition Assessment Form can accurately pre-dict the survival time of terminal patients with advanced cancer,chronic organ failures,dementia and so on.

关 键 词：病情评估单 临终患者 生存期预测 警示指标 姑息治疗 

分 类 号：R48[医药卫生—临床医学]