摘要
目的探讨改良早期预警评分(MEWS)在颅脑外科临床护理工作中的应用价值。方法接诊护士对颅脑外科新收住的204例患者进行MEWS评分,并根据医嘱同时记录入院处置方式(收住ICU和收住普通病房),30 d内追踪预后终点(出院和死亡)。分析MEWS评分各分数段患者不同处置方式的构成比和预后终点的构成比,了解MEWS评分高低与颅脑外科患者的病情及预后的关系;用ROC曲线分评价MEWS评分对判断是否入住ICU的价值和预测出院或死亡的价值。结果 MEWS评分7分以上,危重患者(收住ICU)的构成比明显增加,MEWS评分10分以上死亡构成比显著增加(均P<0.05)。MEWS评分对患者是否应收住ICU的评估能力和对患者病死危险性的预测能力两方面,其ROC曲线下面积分别为0.913和0.805(均P<0.05),说明具有很好的分辨能力,最佳截断点分别为7分和9分。但MEWS评分在分辨是否30 d内治愈或好转出院(还是继续在院治疗)方面,ROC曲线下面积为0.715(P>0.05),欠缺很好的预测能力。结论MEWS评分能较准确地识别颅脑外科危重患者和预测死亡,可提高颅脑外科护士对危重患者病情观察和预后判断的能力。
Objective To investigate the value of modified early warning score （MEWS） in clinical nursing work in cerebral surgery. Methods the nurses rated 204 new admitted patients of cerebral surgery with MEWS, record the in-hospital treatment （admitted to the ICU, admitted to ordinary ward） and tracked the prognosis end of 30 days （discharge and death）. And then analyzed the composition ratio of different treatment and prognosis of the patients in each MEWS band respectively; Applied ROC curve to evaluate the MEWS＂ ability of condition evaluation and predicting the prognosis. Results when MEWS not less than 7 points, the composition ratio of pa- tients admitted to the ICU increased apparently, when not less thanl0 points, the composition ratio of death increased significantly （P 〈0.05）. MEWS score＇s ability to evaluate whether patients should be admitted to the ICU and the ability to predict about the risks of death was strong, the area under the ROC curve are respectively 0.913 and 0.805（P〈O.OS）,with optimal cut-off point of 7 and 9 points respectively. But MEWS ＂ ability to distinguish whether the patients were cured or improved and leave hospital within 30 days was weak because the area under the ROC curve is 0.715（P〉0.05）. Conclusion For cerebral surgery patients, MEWS can accurately iden- tify critical patients and forecast death, so as to improve the nurses＂ ability to observe critical patients and judge their prognosis.
