中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2011年
19期
25-28
,共4页
创伤%重症监护室%改良早期预警评分%急性生理和慢性健康状况评分%预后
創傷%重癥鑑護室%改良早期預警評分%急性生理和慢性健康狀況評分%預後
창상%중증감호실%개량조기예경평분%급성생리화만성건강상황평분%예후
Trauma%Intensive care unit%Modified early warning score%Acute physiology and chronic health evaluation Ⅱ%Prognosis
目的 比较改良早期预警评分(MEWS)和急性生理和慢性健康状况(APACHEⅡ)评分在ICU创伤患者病情评价和预后预测的可行性.方法 回顾性分析综合ICU收治的190例创伤患者的临床资料.入ICU时即刻作为观察起点,通过查阅病历记录对每一例患者分别进行MEWS及APACHEⅡ评分,以经过治疗转出ICU为观察终点,资料收集完后进行统计分析.结果 MEWS与APACHEⅡ评分分值段越高,病死率越高,各分值段比较差异有统计学意义(P＜0.01)；MEWS与APACHEⅡ评分与患者预后呈正相关,相关系数r值分别为0.441、0.525；以死亡为预测指标时,MEWS评分界值是4分,敏感度是88.1％,特异度是51.2％,其ROC曲线下面积AZ=0.763(95％ CI:0.693,0.832),P=0.000; APACHEⅡ评分界值是21分,敏感度是86.6％,特异度是54.5％,其ROC曲线下面积AZ =0.810(95％ CI:0.744,0.876),P=0.000.结论 MEWS与APACHEⅡ评分均可判断ICU创伤患者病情严重程度,对其预后均具有中等程度预测价值,而MEWS操作简单快捷,费用低廉,可实现对患者快速动态的评估病情,更适用于ICU创伤患者.
目的 比較改良早期預警評分(MEWS)和急性生理和慢性健康狀況(APACHEⅡ)評分在ICU創傷患者病情評價和預後預測的可行性.方法 迴顧性分析綜閤ICU收治的190例創傷患者的臨床資料.入ICU時即刻作為觀察起點,通過查閱病歷記錄對每一例患者分彆進行MEWS及APACHEⅡ評分,以經過治療轉齣ICU為觀察終點,資料收集完後進行統計分析.結果 MEWS與APACHEⅡ評分分值段越高,病死率越高,各分值段比較差異有統計學意義(P＜0.01)；MEWS與APACHEⅡ評分與患者預後呈正相關,相關繫數r值分彆為0.441、0.525；以死亡為預測指標時,MEWS評分界值是4分,敏感度是88.1％,特異度是51.2％,其ROC麯線下麵積AZ=0.763(95％ CI:0.693,0.832),P=0.000; APACHEⅡ評分界值是21分,敏感度是86.6％,特異度是54.5％,其ROC麯線下麵積AZ =0.810(95％ CI:0.744,0.876),P=0.000.結論 MEWS與APACHEⅡ評分均可判斷ICU創傷患者病情嚴重程度,對其預後均具有中等程度預測價值,而MEWS操作簡單快捷,費用低廉,可實現對患者快速動態的評估病情,更適用于ICU創傷患者.
목적 비교개량조기예경평분(MEWS)화급성생리화만성건강상황(APACHEⅡ)평분재ICU창상환자병정평개화예후예측적가행성.방법 회고성분석종합ICU수치적190례창상환자적림상자료.입ICU시즉각작위관찰기점,통과사열병력기록대매일례환자분별진행MEWS급APACHEⅡ평분,이경과치료전출ICU위관찰종점,자료수집완후진행통계분석.결과 MEWS여APACHEⅡ평분분치단월고,병사솔월고,각분치단비교차이유통계학의의(P＜0.01)；MEWS여APACHEⅡ평분여환자예후정정상관,상관계수r치분별위0.441、0.525；이사망위예측지표시,MEWS평분계치시4분,민감도시88.1％,특이도시51.2％,기ROC곡선하면적AZ=0.763(95％ CI:0.693,0.832),P=0.000; APACHEⅡ평분계치시21분,민감도시86.6％,특이도시54.5％,기ROC곡선하면적AZ =0.810(95％ CI:0.744,0.876),P=0.000.결론 MEWS여APACHEⅡ평분균가판단ICU창상환자병정엄중정도,대기예후균구유중등정도예측개치,이MEWS조작간단쾌첩,비용저렴,가실현대환자쾌속동태적평고병정,경괄용우ICU창상환자.
Objective To compare the feasibility of MEWS and APACHE Ⅱ in evaluating severity and predicting outcome of trauma patients at intensive care unit.Methods Retrospectively analysis of 190 cases of trauma patients admitted to ICU,through access to medical records for test as soon as they were hospitalized ; Then we gave grade to every patient according to the APACHEⅡ and MEWS separately; We finished the observation after treatment in ICU and took the prognosis as the observing index;Lastly we made the statistical analysis after the data collection.Results The higher the MEWS score and APACHE Ⅱ score segment,the higher the mortality rate was,there was statistically significant difference between segments ( P ＜0.01 ) ; The APACHE Ⅱ and MEWS had positive correlation with patients forecast,r was 0.441,0.525.When choose the death as the forecast index.The cut - off of MEWS grade was 4.Sensitivity was 88.1％,Specificity was 51.2％ ; And area of ROC curve:Az =0.763 (95％ CI:0.693,0.832).P =0.000.The cut - off of APACHE Ⅱ grade was 21,Sensitivity was 86.6％,Specificity was 54.5％ ;and area of ROC curve:Az =0.810(95％ CI:0.744,0.876),P =0.000.Conclusions All of MEWS and APACHE Ⅱ score can be used to evaluate severity and have moderate predictive value of prognosis for ICU trauma patient.MEWS may be the first choice because of simplicity,affordable,allows dynamic assessment of patient' s condition compared with APACHE Ⅱ.
