CAJ | 학술논문

目的：在改良早期预警评分（ MEWS）的基础上进行改进、综合，以建立一种新的评分方法，并探讨这种新的评分方法早期识别急诊潜在危重病患者的可行性。方法记录1235例急诊观察室患者的临床资料，分别进行MEWS和新评分表评分，追踪所有患者的去向和预后。分别比较MEWS和新评分方法不同分数段患者14 d内死亡、＞14 d死亡、住院时间＞14 d、住院时间≤14 d、门诊治疗的构成比；比较MEWS和新评分方法对患者病情评价和预测预后分辨度的ROC曲线差异；比较两种评分方法及与预后的相关性。结果 MEWS 5分以上，危重患者的构成比明显增加，与5分以下比较差异有统计学意义（P＜0．05）。新评分方法5分以上、住院时间＞14 d的患者构成比明显增加（P＜0．05）；10分以上、危重患者构成比明显增加（P＜0．05）；15分以上、＜14 d短期死亡的患者构成比明显增加（ P＜0．05）。就患者短期死亡危险性的预测和评估的鉴别能力而言，新评分方法ROC曲线下面积明显高于MEWS （ P＜0.001）。新评分方法与预后的相关性高于MEWS（P＜0．05），而且转归愈严重的组别新评分分值越大。结论 MEWS和新评分方法均可用于判断急诊患者的病情严重程度，有一定识别“急诊潜在危重病”的能力。而新评分方法可以更好地判断患者的住院周期及短期死亡风险，且只需增加血常规检查，其快速、费用低廉和操作简捷性并不亚于MEWS，更适用于国内的急诊科。
목적：재개량조기예경평분（ MEWS）적기출상진행개진、종합，이건립일충신적평분방법，병탐토저충신적평분방법조기식별급진잠재위중병환자적가행성。방법기록1235례급진관찰실환자적림상자료，분별진행MEWS화신평분표평분，추종소유환자적거향화예후。분별비교MEWS화신평분방법불동분수단환자14 d내사망、＞14 d사망、주원시간＞14 d、주원시간≤14 d、문진치료적구성비；비교MEWS화신평분방법대환자병정평개화예측예후분변도적ROC곡선차이；비교량충평분방법급여예후적상관성。결과 MEWS 5분이상，위중환자적구성비명현증가，여5분이하비교차이유통계학의의（P＜0．05）。신평분방법5분이상、주원시간＞14 d적환자구성비명현증가（P＜0．05）；10분이상、위중환자구성비명현증가（P＜0．05）；15분이상、＜14 d단기사망적환자구성비명현증가（ P＜0．05）。취환자단기사망위험성적예측화평고적감별능력이언，신평분방법ROC곡선하면적명현고우MEWS （ P＜0.001）。신평분방법여예후적상관성고우MEWS（P＜0．05），이차전귀유엄중적조별신평분분치월대。결론 MEWS화신평분방법균가용우판단급진환자적병정엄중정도，유일정식별“급진잠재위중병”적능력。이신평분방법가이경호지판단환자적주원주기급단기사망풍험，차지수증가혈상규검사，기쾌속、비용저렴화조작간첩성병불아우MEWS，경괄용우국내적급진과。
Objective To establish a new scoring method and explore its applicability in the identification of patients with emergency potential severity disease , through the amelioration of the modified early warning score ( MEWS ) .Methods Clinical profiles of 1235 patients presented at the emergency room were recorded and scored via MEWS and the new score method separately .Their next treatments and prognosis were followed up .The constituent ratios of death within 14 d, death after 14 d, length of stay more than 14 d, length of stay less than or equal to 14 d and outpatient treatment were compared among patients in different score ranges by MEWS and the new one; their ROC curves were compared in the evaluation and prediction on patients'prognosis; and the correlations between the two scoring methods and their correlation with the patients'prognosis were compared respectively .Results For those who scored 5 or above by MEWS , the constituent ratio of critically ill patients was significantly increased, compared to that of those who scored less than 5 ( P<0.05).For those who scored 5 or above by the new scoring method , the constituent ration of patients'length of stay more than 14 d was significantly increased ( P <0.05 ); above 10, the constituent ratio of critically ill patients was significantly increased ( P <0.05 ); above 15, constituent ration of patients'death within 14 d was significantly increased (P<0.05).For the identification ability of the evaluation and prediction on the risk of death within a short term , the new scoring method had a bigger proportion under the ROC curve than that of the MEWS scoring (P<0.001).The new scoring method was more correlative than MEWS scoring with the prognosis (P<0.05), and the more severe the prognosis was , the larger the score by the new method would be .Conclusion Both the MEWS and the new scoring method can be used in evaluating the severity of emergency patients'illnesses, which could help to identify some emergency potential severity disease .The new scoring method functions better in judging the length of stay and short-term risk of death for the emergency patient with only an additional blood routine examination , whose rapidness, low expense and convenience is comparable to MEWS .Therefore, the new scoring method is more suitable for the domestic emergency department .