改良早期预警评分在评估院前急性中毒患者病情及预后的应用研究

Clinical application of modified early warning scores assessing the conditions and prognosis of pre-hospital acute poisoning

目的 研究改良早期预警评分（modified early warning scores,MEWS）在院前急性中毒患者病情评估和死亡预测的价值及可行性.方法 以2010年1月1日至2010年12月31日院前急性中毒患者作为研究对象,进行前瞻性观察性研究,现场采集相关数据,进行MEWS评分,以收入院后90 d为观察终点,结局作为观察指标.计数资料以百分比表示,用x2检验,计量资料以均数＆#177;标准差（（x）＆#177;s）表示,用成组t检验,以P ＜0.05为差异具有统计学意义,对患者进行MEWS评分工作特征曲线（receiver operating characteristic curve,ROC）下面积计算,计算患者相应的预测指标.结果 0～6分的患者287例次,占94.4％;7～13分共17例次,占5.59％;死亡组MEWS评分较存活组高,差异有统计学意义（P＜0.05）;MEWS评分ROC曲线下面积为0.99,判断院前中毒患者“潜在危重症”的最佳截断点为≥7分,对危重症患者死亡预测的敏感度91.7％,特异度为97.9％,准确度为97.7％,约登指数为0.896.表明MEWS评分在急性中毒患者病情评估及死亡的预测具有较强的应用价值.结论 MEWS评分对院前急性中毒患者病情评估及死亡的预测具有较高的分辨能力,此评分方法简单、实用、可操作性强,有较强的应用价值.

Objective To study the significance and feasibility of modified early warning scores （MEWS） assessing the conditions and death prediction among the pre-hospital acute poisoning patients.Methods We performed a prospective,observational study of the pre-hospital acute poisoning patients between January 1,2010 and December 31,2010.Data was collected to calculate the MEWS.Numeration data was presented in percentage by using chi-square test,and measurement data was expressed in mean with standard deviation,and P 〈 0.05 was considered to be different with statistical significance.Observation lasted for 90 days after admission to get the results as observation index and ROC was drew and the area under the curve and the predicting index were calculated.The patients without vital signs and unsuccessful resuscitation were not included in this study.Results It showed 287 person times with 0 ～ 6 scores,accounting 94.4%,17 person times with 7-13 scores,accounting 5.59%,among the dead patients,MEWS were more than those of the survival group with statistical significance （P 〈 0.05）.The area under ROC was 0.99 indicating that MEWS≥7 was the board line for severe pre-hospital acute poisoning patients with sensitivity of 91.7%,specificity of 97.9%,accuracy of 97.7% and Youden of 0.896 for predicting death.It showed high significance of the application of MEWS in assessing acute poisoning patients and death prediction.Conclusions MEWS assess pre-hospital acute poisoning patients and predict death with good resolution and strong application significance,which is simple,practical and applicable.