改良早期预警评分系统在院前与院内急救无缝隙链接中的临床应用研究

Study on the application of modified early warning score （ MEWS ） for pre - hospital and in - hospital emergency treatment

目的 研究改良早期预警评分（MEWS）系统在院前与院内急救无缝隙链接中的应用,采用MEWS系统设计院前急救程序化监护,对院前急救患者意外事件发生率和预后的影响,探讨该系统在院前与院内急救无缝隙链接方面的价值.方法 将我院院前急救患者分为两组：对照组为 2005-01 ～2006-12（4026例）院前急救患者,试验组为2007-01 ～2008-12（5203例）院前急救患者;对照组按照院前急救常规监护方案实施管理,试验组采用MEWS系统设计院前急救程序化监护及院前与院内急救无缝隙链接管理方法,比较两组院前急救患者24 h留观意外事件发生率,收住院患者30 d病死率是否存在差异.结果 试验组与对照组相比,留观患者意外事件发生率间差异有统计学意义（χ2=5.80,P＜0.05）;30 d病死率比较差异有统计学意义（χ2=39.60,P＜0.01）.试验组病情评估及综合管理更完整、更科学、更实用及急救处理更准确.结论 本研究为医院急诊学科建立一个规范且共享性强的院前急救程序化监护,设计一个院前与院内,急救无缝隙链接实施方案;为更好开展现场急救,高效转送,缩短接收医院进入状态的时间提供了最新的科学资料和依据.

Objective To investigate the value of modified early warning score （MEWS）in connection of no blind side chain of pre - hospital and in - hospital emergency treatment. Methods The patients were divided into two groups ： control group, 4026 emergency cases from Jan. 2005 to Dec. 2006,and trial group,5203 emergency cases from Jan. 2007 to Dec. 2008. In control group, the patients were treated according to the traditional emergency care program of the hospital. In trial group, the patients were treated according to a new program, in which MEWS were applied to connection of no blind side chain of pre - hospital and in - hospital emergency treatment. Rates of the accidents occurring in the patients kept 24 - hour observation in emergency department, and mortality rates of hospitalized patients within 30 days after emergency were compared. Results There was obvious difference in the rate of accidents occurring in the patients kept 24 - hour observation in emergency department （x^2 = 5.80, P 〈 0. 05 ） and mortality rate of 30 days （x^2 = 39.60 ,P 〈 0. 01 ） between two groups in statistics. The program of disease severity assessment and emergency integrative management applied in the trial group was more fine and complete, more scientific, more practical, and the emergency treatment was more accurate. Conclusion The application of MEWS to completing connection of no blind side chain of pre - hospital and in - hospital emergency treatment leads to a high - efficiency, standardized and resource - sharing emergency care program, which shows a bright prospect.