改良早期预警评分与校正改良预警评分在外科术后患者中的应用对比研究

Application of modified early warning score and calibrated modified early warning score in surgical in-patients

目的：探讨改良早期预警评分（MEWS）与校正MEWS在外科病房手术后患者的应用价值对比.方法：回顾性分析外科病房收治的171例外科手术后患者的临床资料.手术后入病房时即刻作为观察起点,通过查阅病例记录对每一例患者分别进行MEWS和校正MEWS评分,以转出病房为观察终点,资料收集完后进行统计分析.结果：MEWS与校正MEWS评分分值段越高,患者自动出院/死亡、转入ICU比例明显增加,与低分段比较具有统计学意义（P＜0.01）；以收入ICU为预测指标时,MEWS界值是4,敏感度是54.5％,特异度是90.6％,其ROC曲线下面积（0.878士0.030）（95％：0.848～0.908,P=0.000）；校正MEWS界值是5,敏感度是59.1％,特异度是89.3％,其ROC曲线下面积（0.907士0.023）（95％：0.884～0.930,P=0.000）.结论：校正MEWS比MEWS评分更能反映外科术后患者病情危重程度,是提高监护级别的扳机点；观察数据护士易于获得,值得在外科病房中推广应用.

Objective： To compare the application of modified early warning score { MEWS} and calibrated MEWS in surgical in- patient care. Methods： The MEWS and calibrated MEWS of 171 operation patients at the time of hospitalization in surgical ward were analyzed retrospectively. Results： The incidence of automatic discharge or death or transferred to ICU increased significantly in patients of higher MEWS and calibrated MEWS. The difference had statistical significance compared with lower grade （P〈0.01）. Transferred to ICU as predictor, the MEWS assessment boundary value was 4, the sensitivity was 54.5%, specific degree was 90.6%, the area under the ROC curve was （0. 878±0.030） （95%, 0. 848±0. 848, P= 0. 000） ; while Calibrated MEWS assessment boundary value was 5, sensitivity was 59.1 %, specific degree was 89.3 %, the area under the ROC curve was （0. 907±0. 023） （95%, 0. 884±0. 884, P=0. 000）. Conclusion： Comparing with MEWS, Calibrated MEWS can reflect the degree of postoperative surgical patients in a critical condition, improve the monitoring level of the trigger point and easy to get by nurses. It is worth popularizing and applying in the surgical ward.