MEWS、SIRS和MEES系统综合用于急诊内科患者48h内病情评估的价值

The Value of the MEWS,SIRS and MEES Systems in the Assessment of Disease Within 48 Hours for Emergency Medical Patients

目的了解MEWS、SIRS和MEES系统综合用于急诊内科患者48h内病情评估的价值,为急诊科护理工作的预先开展提供理论依据。方法调查医院急诊科留观区收治的符合调查要求的内科疾病患者165例,比较病情稳定和不稳定患者MEWS、SIRS、MEES评分系统各指标得分的差异,分析3个系统串联使用用于病情评估的准确率,并构建多因素回归模型。结果急诊留观室内科患者165例中实际病情稳定的患者118例(占71.52%)、不稳定的47例(占28.48%);病情稳定和不稳定患者MEWS评分各指标和总分均有统计学意义(均P<0.05);SIRS评分各指标和总分均有统计学意义(均P<0.05);MEES评分各指标和总分均有统计学意义(均P<0.05);MEWS评分、SIRS评分、MEES评分、3评分系统串联分别用于患者病情评估的准确度依次为:80.85%、65.96%、59.57%、97.87%,约登指数依次为0.30、0.33、0.22、0.90;各评分系统评定结果与患者病情所拟合的多因素回归方程有统计学意义(Chi-Square检验,X^2=140.193,P=0.000),各评分系统对结果影响大小依次为:SIRS评分Exp(B)=4.914、MEWS评分Exp(B)=3.916、MEES评分Exp(B)=3.575。结论 3个评分系统用于急诊科所收治的内科患者进行48h内病情稳定性的评估,准确率从大到小依次是:MEWS、SIRS、MEES评分系统;3个评分系统的串联使用有助于提高诊断准确性,所拟合的多因素回顾模型可尝试用于患者入院后48h病情稳定性的预判。

Objective To understand the value of MEWS, SIRS and MEES in the assessment of 48 hours of emer-gency medical patients, and to provide theoretical basis for pre - development of emergency department nursing work. Meth-ods A total of 165 patients with internal medicine diseases were enrolled in this study. The differences of MEWS, SIRS and MEES scoring system scores were analyzed. The three systems were used in series to evaluate the disease to construct a multi-variate regression model. Results There were 118 patients （7 1 . 52% ） with unstable disease and 165 patients （28. 48% ） . There were statistically significant differences in MEWS scores and total scores in patients with stable and unstable patients （P 〈 0. 05 ） ; MEWS score, SIRS score, MEES score （P 〈 0. 05 ） ; The mean and the total score of SIRS score were statisti-cally significant （P 〈0. 05） . The scores of the scoring system were in the range of 80.85% , 65.96% , 59.57% and 97. 87% respectively, and the Gordon index was 0. 30, 0. 33 , 0. 22 and 0. 90 respectively. The scores of the scoring system were statistically significant （Chi - square test, χ^2 = 140. 193 , P = 0. 0 0 0 ） , and the effect of the scoring system on the re-sults was SIRS score Exp （B） =4. 9 1 4 , MEWS score Exp （B ） = 3 . 9 1 6 , MEES score Exp （B ） = 3 . 575. Conclusion The scores of the three scoring systems were used to evaluate the stability of the patients in the emergency department within 48 hours. The accuracy rate was from the following： MEWS, SIRS, MEES scoring system; The use of the three scoring systems to improve the diagnostic accuracy, the fitted multivariate review model can be used to predict the conditional stability of the patient within 48 hours after admission.