院前急救患者的改良早期预警评分分布及应用的临床研究

Distributions and clinical application of modified early warning scores in pre - hospital emergency patients

目的 研究院前急救患者的改良早期预警评分（MEWS）的分布特点及其临床应用的价值.方法 对院前急救患者的MEWS现场评分的分布特点和临床价值等进行观察、分析和研究.结果 院前急救患者以MEWS评分1～3分的低分患者为主,占80.88%,而0分、4～13分等10个评分患者之和仅占19.12%.在MEWS评分较低的0～3分的患者中,各个分值间病死率比较差异无统计学意义（P〉0.05）,死亡原因主要是冠脉综合征导致的猝死.而MEWS评分≥4分时,收住专科病房和重症监护病房治疗的患者比率显著增加,病死率也显著增加,与MEWS评分0～3分的患者病情危重度和病死率比较及其各分值组间比较差异均有统计学意义（P〈0.05或P〈0.01）.结论 MEWS评分具有评估院前急救患者病情和预测潜在死亡危险的作用,对于MEWS≥4分的重症患者,积极采取防治措施,严密监护,对减少院前死亡和提高抢救成功率有重要的临床意义.

Objective To discuss the characteristics of the distributions and clinical application of the modified early warning scores （MEWS） in pre - hospital emergency patients. Methods The characteristics of the distributions and clinical significance of the MEWS in pre - hospital emergency patients were observed anti analyzed. Results The patients with MEWS of 1 -3 accounted for 80.88% and the patients with MEWS of 0 and 4 - 13 accounted for 19.12% alone. There was no significant difference in mortality among the patients with low MEWS of 0 - 3 （ P 〉 0.05 ）. The causes of death were mainly sudden death due to coronary heart syndromes which could be reduced through dynamic monitoring of MEWS. For the patients with MEWS≥4, rate of hospitalization and admitted to ICU increased and the mortality increased significantly too. There was significant difference in the severity and mortality between the patients with MEWS 〈 4 and those with MEWS ≥ 4 （ P 〈 0. 01 ）, which indicated MEWS≥ 4 was the cutoff value for critical illness and predicting the risk of death. Conclusion MEWS is a good tool to assess the pre - hospital emergency patients, which can assess and categorize the patients＇ conditions and predict the risks of potential death. It is fast, practical and easy for clinical application.