中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
8期
687-690
,共4页
顾明%付阳阳%李晨%陈铭裕%张晓毳%徐军%于学忠
顧明%付暘暘%李晨%陳銘裕%張曉毳%徐軍%于學忠
고명%부양양%리신%진명유%장효취%서군%우학충
改良早期预警评分%急诊重症患者%病死率%预后
改良早期預警評分%急診重癥患者%病死率%預後
개량조기예경평분%급진중증환자%병사솔%예후
Modified early warning score%Critically ill patient in emergenc departemnt%Mortality%Outcome
目的：探讨改良早期预警评分（MEWS）对急诊重症患者早期预后的预测价值。方法采用前瞻性队列研究方法，连续入选2014年2月13日至4月20日在北京协和医院急诊抢救室就诊患者，记录患者临床资料，进行MEWS评分并随访患者临床转归，比较MEWS阳性组（MEWS≥5分）和MEWS阴性组（MEWS 0～4分）患者主要终点（3 d内死亡）及次要终点〔所有死亡，以及转入重症加强治疗病房（ICU）、心肺复苏（CPR）和死亡联合终点〕的发生率，采用多因素回归分析主要终点的影响因素。结果入选176例临床资料完整的患者，平均年龄（56.86±21.46）岁；男性98例，占55.68%；平均MEWS评分（4.30±2.74）分。MEWS阳性组74例，MEWS阴性组102例。共有41例患者出现主要终点，MEWS阳性组3 d内病死率显著高于MEWS阴性组〔37.84%（28/74）比12.74%（13/102），优势比（OR）＝4.167，95%可信区间（95%CI）＝1.973～8.804，P＜0.001〕。次要终点事件中，MEWS阳性组所有死亡〔54.05%（40/74）比17.65%（18/102），OR＝5.490，95%CI＝2.770～10.883，P＜0.001〕以及转入ICU、CPR和死亡联合终点〔64.86%（48/74）比25.49%（26/102），OR＝5.396，95%CI＝2.809～10.366，P＜0.001〕发生率也显著高于MEWS阴性组。多因素回归分析显示，意识状态异常是3 d内死亡的预测因子（OR＝3.606，95%CI＝1.541～8.436，P＝0.003），而MEWS≥5分则不是（OR＝1.672，95%CI＝0.622～4.494，P＝0.308）。结论尽管MEWS≥5分的急诊重症患者较MEWS 0～4分患者发生严重不良事件风险显著增加，但MEWS≥5分不能有效预测患者3 d内死亡的风险，而意识状态改变对急诊重症患者的早期死亡具有一定预测意义。
目的：探討改良早期預警評分（MEWS）對急診重癥患者早期預後的預測價值。方法採用前瞻性隊列研究方法，連續入選2014年2月13日至4月20日在北京協和醫院急診搶救室就診患者，記錄患者臨床資料，進行MEWS評分併隨訪患者臨床轉歸，比較MEWS暘性組（MEWS≥5分）和MEWS陰性組（MEWS 0～4分）患者主要終點（3 d內死亡）及次要終點〔所有死亡，以及轉入重癥加彊治療病房（ICU）、心肺複囌（CPR）和死亡聯閤終點〕的髮生率，採用多因素迴歸分析主要終點的影響因素。結果入選176例臨床資料完整的患者，平均年齡（56.86±21.46）歲；男性98例，佔55.68%；平均MEWS評分（4.30±2.74）分。MEWS暘性組74例，MEWS陰性組102例。共有41例患者齣現主要終點，MEWS暘性組3 d內病死率顯著高于MEWS陰性組〔37.84%（28/74）比12.74%（13/102），優勢比（OR）＝4.167，95%可信區間（95%CI）＝1.973～8.804，P＜0.001〕。次要終點事件中，MEWS暘性組所有死亡〔54.05%（40/74）比17.65%（18/102），OR＝5.490，95%CI＝2.770～10.883，P＜0.001〕以及轉入ICU、CPR和死亡聯閤終點〔64.86%（48/74）比25.49%（26/102），OR＝5.396，95%CI＝2.809～10.366，P＜0.001〕髮生率也顯著高于MEWS陰性組。多因素迴歸分析顯示，意識狀態異常是3 d內死亡的預測因子（OR＝3.606，95%CI＝1.541～8.436，P＝0.003），而MEWS≥5分則不是（OR＝1.672，95%CI＝0.622～4.494，P＝0.308）。結論儘管MEWS≥5分的急診重癥患者較MEWS 0～4分患者髮生嚴重不良事件風險顯著增加，但MEWS≥5分不能有效預測患者3 d內死亡的風險，而意識狀態改變對急診重癥患者的早期死亡具有一定預測意義。
목적：탐토개량조기예경평분（MEWS）대급진중증환자조기예후적예측개치。방법채용전첨성대렬연구방법，련속입선2014년2월13일지4월20일재북경협화의원급진창구실취진환자，기록환자림상자료，진행MEWS평분병수방환자림상전귀，비교MEWS양성조（MEWS≥5분）화MEWS음성조（MEWS 0～4분）환자주요종점（3 d내사망）급차요종점〔소유사망，이급전입중증가강치료병방（ICU）、심폐복소（CPR）화사망연합종점〕적발생솔，채용다인소회귀분석주요종점적영향인소。결과입선176례림상자료완정적환자，평균년령（56.86±21.46）세；남성98례，점55.68%；평균MEWS평분（4.30±2.74）분。MEWS양성조74례，MEWS음성조102례。공유41례환자출현주요종점，MEWS양성조3 d내병사솔현저고우MEWS음성조〔37.84%（28/74）비12.74%（13/102），우세비（OR）＝4.167，95%가신구간（95%CI）＝1.973～8.804，P＜0.001〕。차요종점사건중，MEWS양성조소유사망〔54.05%（40/74）비17.65%（18/102），OR＝5.490，95%CI＝2.770～10.883，P＜0.001〕이급전입ICU、CPR화사망연합종점〔64.86%（48/74）비25.49%（26/102），OR＝5.396，95%CI＝2.809～10.366，P＜0.001〕발생솔야현저고우MEWS음성조。다인소회귀분석현시，의식상태이상시3 d내사망적예측인자（OR＝3.606，95%CI＝1.541～8.436，P＝0.003），이MEWS≥5분칙불시（OR＝1.672，95%CI＝0.622～4.494，P＝0.308）。결론진관MEWS≥5분적급진중증환자교MEWS 0～4분환자발생엄중불량사건풍험현저증가，단MEWS≥5분불능유효예측환자3 d내사망적풍험，이의식상태개변대급진중증환자적조기사망구유일정예측의의。
ObjectiveTo evaluate the value of modified early warning score (MEWS) in predicting mortality of critically ill patients admitted to emergency department.Methods A prospective cohort study was conducted. Clinical data of emergency patients admitted to resuscitation room of Peking Union Medical College Hospital from Feburary 13rd, 2014 to April 20th, 2014 were collected, and their MEWS were calculated based on medical records and their clinical outcomes was followed. Incidence of primary outcome (3-day mortality) and secondary outcome [all deaths and composite outcome of intensive care unit (ICU) transfer, cardio-pulmonary resuscitation, and death] were compared between MEWS positive (MEWS≥5) or negative (MEWS 0-4) patients, and multi-regression logistic analysis was done to look for the impact factors of primary outcome in these patients.Results 176 patients, among them 98 (55.68%) were male, were enrolled in the study. Their mean age was (56.86±21.46) years old. Mean MEWS was 4.30±2.74. There was 74 cases in MEWS positive group, and 102 in negative group. Primary endpoint occurred in 41 patients, and the 3-days mortality in MEWS positive group was significantly higher than that in MEWS negative group [37.84 (28/74) vs. 12.74% (13/102), odds ratio (OR) = 4.167, 95% confidence interval (95%CI) = 1.973-8.804,P< 0.001]. At the meantime, incidence of all death [54.05% (40/74) vs. 17.65% (18/102),OR = 5.490, 95%CI = 2.770-10.883,P< 0.001] and the incidence of ICU transfer, cardio-pulmonary resuscitation and death [64.86% (48/74) vs. 25.49% (26/102),OR = 5.396, 95%CI = 2.809-10.366,P< 0.001] were also significantly higher in MEWS positive group as compared with negative group. Multi-regression logistic showed abnormal mental status (OR = 3.606, 95%CI = 1.541-8.436,P = 0.003) but not MEWS≥5 (OR = 1.672, 95%CI = 0.622-4.494,P = 0.308)was the predictor of 3-day mortality in emergency admitted critically ill patients.Conclusions Although the incidence of severe adverse events is significantly increased in patients with MEWS≥5 compared with those with MEWS 0-4, MEWS≥5 cannot be an efficient predictor for 3-day mortality. Abnormal mental status shows some predictive value for early mortality in critically ill patients seen in emergency department.
