MEWS、REMS、APACHEⅡ、SAPSⅡ4种评分系统在老年危重患者中的相关性研究及对预后的评估

Correlation of MEWS,REMS,APACHEⅡ,SAPSⅡ scores and their prognostic values in aged critical patients

目的探讨改良早期预警(modified early warning score,MEWS)评分、快速急诊内科(rapid emergency medicine score,REMS)评分、急性生理学及慢性健康状况Ⅱ(acute physiology and chronic health evaluationsⅡ,APACHEⅡ)评分、简化急性生理Ⅱ(simplified acute physiology socreⅡ,SAPSⅡ)评分在老年危重患者中的相关性及对预后评估的准确性。方法分析入选的150例老年危重患者4种评分情况,统计患者治疗后28天病死率,比较死亡组和生存组间各评分之间是否存在差异。并分析4种评分间的相关性及利用受试者工作特征(ROC)曲线探究4种评分对患者预后的评估能力。结果 4种评分在死亡组与存活组间差异具有统计学意义。4种评分间均互呈正相关关系。通过ROC曲线分析显示:4种评分对患者预后均具有一定评估能力。APACHEⅡ评分的评估准确性优于SAPSⅡ、REMS评分、MEWS评分。SAPSⅡ评分评估准确性同样优于REMS评分和MEWS评分。REMS评分和MEWS评分评估准确性相当。结论 4种评分系统对急诊老年患者预后均具有评估意义。急诊早期MEWS评分、REMS评分与ICU病房APACHEⅡ评分、SAPSⅡ评分间对患者预后评估具有一致性。急诊早期可行MEWS评分、REMS评分评估患者病情,对可能预后不良患者早期ICU病房进行分诊,进一步根据不同情况行APACHEⅡ评分和SAPSⅡ评分动态观察、综合评估,同时各评分系统间相互结合与补充,适时采取临床相关干预措施,调整诊疗方案,挽救患者生命。

Objective To explore the correlation and the prognostic value of modified early warning score （MEWS）, rapid emergency medicine score（REMS）, acute physiology and chronic health evaluations Ⅱ （APACHE Ⅱ ）, simplified acute physiology score Ⅱ （SAPS Ⅱ ） in the aged critical patients. Methods The clinical data of 150 aged critical patients were prospectively collected for MEWS, REMS, APACHE Ⅱ , SAPS scoring. The mortality of the patients at 28 d after the treatment were recorded. Then, the comparisons of each parameter between the death group and survival group were performed. The correlation analysis among the four scorings were carried out and their prognostic values for the patients were also evaluated using ROC curve. Results The results of the four scorings showed significant difference between the death group and the survival group. Moreover, they were positively correlated with each other. APACHE Ⅱ was the best for prognosis in the four scorings, followed by SAPS l/. However, there was no significant difference between REMS and MEWS. Conclusion All the four scorings have significant diagnostic values for the aged critical patients. MEWS,REMS shared similar significances to APACHE Ⅱ , SAPS Ⅱ for evaluating the prognosis of patients. At the early stage of emergency, REMS and MEWS play an important role to evaluate the prognosis of patients, while APACHE Ⅱ and SAPS Ⅱ can be used for dynamic observation on the patients with more severe conditions. Thus, according to the combined application of the four scorings, the treatment options can be adjusted in time.