改良早期预警评分及危险病人评分对急诊科抢救室病人预后的评估价值

Value of MEWS and PARS in evaluating the prognosis of emergency patients

目的:探讨改良早期预警评分(MEWS)及危险病人评分(PARS)对急诊科抢救室病人预后的评估价值。方法:回顾性分析2 931例急诊科病人的临床资料,包括性别、年龄、呼吸频率、心率、血压(收缩压)、血氧饱和度、体温(腋温)、意识水平及持续4 h尿量等,并于病人入院0、2、24 h分别采用MEWS和PARS评分进行评估,比较不同时点MEWS和PARS评分对病人预后预测的ROC曲线下面积(AUC)。结果:病人入院0、2、24 h,PARS预测病人预后的AUC分别为0. 936、0. 950、0. 827,MEWS的AUC分别为0. 915、0. 932、0. 825,2种评分各时点的AUC差异均无统计学意义(P> 0. 05)。以病人入院后2周的MEWS及PARS评分为依据,MEWS≥4. 5分病人死亡率(11. 04%)高于MEWS <4. 5分病人(6. 30%)(P <0. 05); PARS≥4. 5分病人死亡率(12. 73%)明显高于PARS <4. 5分病人(6. 19%)(P <0. 01)。结论:MEWS和PARS评分对急科抢救室病人预后均有良好的评估价值,其中MEWS评分参数更少,更加简便、快捷,入院即刻即可进行评估。

Objective： To investigate the value of modified early warning score（MEWS） and patient at risk score（PARS） in evaluating the prognosis of emergency patients.Methods： The general clinical data,which included gender,age,respiratory rate,heart rate,blood pressure（systolic blood pressure）,blood oxygen saturation,temperature（axillary temperature）,level of consciousness and lasting 4 hours urine volume,in 2 931 emergency patients were retrospectively analyzed.At 0,2 and 24 h of admission,the patients were evaluated using MEWS and PARS,and the area under curve（AUC） of ROC of prognosis predicted by MEWS and PARS were compared at different time-points.Results： At 0,2 and 24 h of admission,the AUC of ROC of prognosis predicted by PARS was 0.936,0.950 and 0.827,respectively,the AUC of ROC of prognosis predicted by MEWS was 0.915,0.932 and 0.825,respectively,and the differences of AUC at all time-points were not statistically significant（ P 〉0.05）.According to the MEWS and PARS scores after 2 weeks of admission,the mortality rate in patients with MEWS ≥4.5（11.04%） was higher than that in patients with MEWS 〈4.5（6.30%） （ P 〈 0.05）,and the mortality in patients with PARS ≥4.5（12.73%） was significantly higher than that in patients with PARS 〈4.5（6.19%）（ P 〈0.01）.Conclusions： The MEWS and PARS have good evaluation value in the prognosis of emergency patients.The MEWS has little parameter,is simple,quick and efficient,and can be evaluated at admission.