用改良的早期预警评分系统联合休克指数对接受院前急救多发伤患者的病情进行评估的效果探讨

Application effect of Modified Early Warning Scoring System combined with Shock index System for appraisal of Multiple trauma patients in the Pre-hospital Emergency Care

目的 :探讨用改良的早期预警评分系统(MEWS)联合休克指数对接受院前急救多发伤患者的病情进行评估的效果。方法 :回顾性地分析2010年1月至2015年6月期间某院急诊科收治的接受院前急救的80例多发伤患者的临床资料。分别使用MEWS与MEWS联合休克指数对这些患者的病情进行评估。以30 d后患者的预后作为观察的终点。比较不同预后的多发伤院前急救患者其MEWS评分与MEWS和休克指数的评分。结果 :在这80例多发伤院前急救患者中,死亡的患者有13例,存活的患者有67例,入ICU接受治疗的患者有25例,入专科接受治疗的患者有45例。死亡、存活和入ICU接受治疗患者的MEWS评分与MEWS和休克指数评分相比差异均具有统计学意义(P<0.05)。进入专科接受治疗的45例患者其MEWS评分与MEWS和休克指数评分相比差异不具有统计学意义(P>0.05)。随着多发伤院前急救患者MEWS评分与MEWS联合休克指数评分的升高,其死亡率明显升高。当MEWS评分达到6.5分时,用其评估患者病情的灵敏度为90%,特异度为80.6%,此时的youden指数最大。当MEWS联合休克指数评分达到8.5分时,用其评估患者病情的灵敏度为95%,特异度为63.8%,此时的youden指数最大。用MEWS评分与MEWS联合休克指数评分预测80例多发伤院前急救患者死亡的ROC曲线下面积相比差异具有统计学意义(P<0.01)。结论 :用改良的早期预警评分系统联合休克指数对接受院前急救的多发伤患者的病情进行评估的效果较为理想。

Objective： To study application effect of Modified Early Warning Scoring System（MEWS） combined with Shock index System（SI） for appraisal of Multiple trauma patients in the Pre-hospital Emergency Care. Methods： Retrospectively study the material of 80 cases of Multiple trauma patients in the Pre-hospital Emergency Care in a hospital from Janurary 2010 to June 2016. Evaluating severity of the patients with MEWS and SI respectively.Set prognosis after 30 d as endpoint of observation,compare MEWS score and MEWS and SI combined score of patients of different prognosis. Results：In the 80 cases,there are 13 cases died,67 cases survive,25 cases was accepted ICU treatment,45 cases accepted specific treatment.Difference of MEWS score and MEWS and SI combined score of died patients,survival patients and patients accepted ICU treatment have statistical significant（P 0.05）.Difference of MEWS and MEWS and SI combined score of 45 patients accepted specific treatment have no statistical significant（P 0.05）.Accompanied by increasing of MEWS score and MEWS and SI combined score,death rate was increasing.When MEWS score reached to 6.5, MEWS sensitivity is 90% and MEWS specificity is 80.6%,youden index reached maximum.When MEWS and SI combined score reached to 8.5, sensitivity of MEWS combined with SI is 95%, specificity of MEWS combined with SI is 63.8%, youden index reached maximum.Apply MEWS and MEWS combined with SI for prognosticate 80 cases of Multiple trauma patients in the Pre-hospital Emergency Care death area under ROC curve, the differece have statistical significant（P 0.05）.Conclusion：Effect of Modified Early Warning Scoring System（MEWS） combined with Shock index System（SI） for appraisal of Multiple trauma patients in the Pre-hospital Emergency Care is good.