CAJ | 학술논문

目的研究改良早期预警评分(MEWS)系统在院前创伤患者病情评估和死亡预测的价值及可行性.方法以广西医科大学第四附属医院2010年1月1日至2010年12月31日院前创伤患者作为研究对象,现场采集相关数据,进行MEWS评分,以收入院后90d为观察终点,结局作为观察指标,计数资料以百分比表示,用X2检验,计量资料以均数±标准差((-x)±s)表示,用成组t检验,以P＜0.05为差异具有统计学意义.对患者进行MEWS评分工作特征曲线(ROC曲线)下面积计算,计算患者相应的预测指标.本研究对象不包括院前无生命体征且复苏无效的伤者.结果 0～2分的患者1475例次,占87.95％,3～13分共202例次,占12.05％；死亡组MEWS评分较存活组高,差异具有统计学意义(P＜0.01)；MEWS评分ROC曲线下面积为0.944,判断院前创伤患者“潜在危重症”的最佳截断点为≥3分,对危重症患者死亡预测的敏感度86.7％,特异度为88.6％,准确度为88.6％,约登指数为0.753.表明MEWS评分在创伤患者病情评估及死亡的预测具有较强的应用价值.结论 MEWS评分对院前创伤患者病情评估及死亡的预测具有较高的分辨能力,此评分方法为简单、实用、可操作性强,有较强的应用价值.
목적 연구개량조기예경평분(MEWS)계통재원전창상환자병정평고화사망예측적개치급가행성.방법 이엄서의과대학제사부속의원2010년1월1일지2010년12월31일원전창상환자작위연구대상,현장채집상관수거,진행MEWS평분,이수입원후90d위관찰종점,결국작위관찰지표,계수자료이백분비표시,용X2검험,계량자료이균수±표준차((-x)±s)표시,용성조t검험,이P＜0.05위차이구유통계학의의.대환자진행MEWS평분공작특정곡선(ROC곡선)하면적계산,계산환자상응적예측지표.본연구대상불포괄원전무생명체정차복소무효적상자.결과 0～2분적환자1475례차,점87.95％,3～13분공202례차,점12.05％；사망조MEWS평분교존활조고,차이구유통계학의의(P＜0.01)；MEWS평분ROC곡선하면적위0.944,판단원전창상환자“잠재위중증”적최가절단점위≥3분,대위중증환자사망예측적민감도86.7％,특이도위88.6％,준학도위88.6％,약등지수위0.753.표명MEWS평분재창상환자병정평고급사망적예측구유교강적응용개치.결론 MEWS평분대원전창상환자병정평고급사망적예측구유교고적분변능력,차평분방법위간단、실용、가조작성강,유교강적응용개치.
Objective To study the feasibility of modified early warning scores (MEWS) for assessing the severity and death prediction in the pre-hospital traumatic patients.Methods Data of the prehospital traumatic patients admitted between January 1,2010 and December 31,2010 were collected and assessed onsite by using MEWS.Numeration data was presented in percentage by using chi-square test,and measurement data was xepressed in mean with standard deviation,and P ＜ 0.05 was considered to be difference with statistical significance.Observation was lasted for 90 days after admission to get final results as observation object and ROC curve was drew and calculated the area under the curve for predicting severity and death of patients.The patients without vital signs and unsuccessful resuscitations were not included in this study.Results There were 1475 (87.95％) cases/times with score of 0 -2,and 202 (12.05％)cases/times with score of 3 - 13.In the non-survival group,MEWS were higher than that in the survival group with statistic significance ( P ＜ 0.01 ).When the area under ROC was 0.94,the optimal cutoff point for potentially severe patients was MEWS≥3 for predicting the death of severe pre-hospital traumatic patients with sensitivity of 85.7％,specificity of 88.6％,accuracy of 88.6％ and Youden of 0.743,showing high significance of the application of MEWS to assessing severity of traumatic patients and death prediction.Conclusions MEWS used to assess the pre-hospital traumatic patients and predict death with high validity and accurate quantification is a simple,practical and easily operable method with strong application significance.