MEWS评分识别危重症患者的临床研究

目的探讨改良早期预警评分(Modified Early Warningscore,MEWS)识别危重症患者的临床应用价值。方法收集360例死亡患者的相关临床资料-包括性别、年龄、生命体征、呼吸支持、氧饱和度、意识、尿量、化验、诊断等。不同参数组合产生4种MEWS评分,即MEWSa、MEWSb、MEWSc、MEWSd。分别对360例病人同时进行MEWS评分和APACHEⅡ评分。统计方法采用相关性分析、ROC曲线及多个独立样本非参数检验,以探讨4种MEWS评分方法和APACHEⅡ评分的相关性,4种MEWS评分之间的差异。结果4种MEWS评分与APACHEⅡ评分均显示较好的相关性,(P均<0.001)。区分危重症患者的拟定最佳界点均为3分。其中MEWSa、MEWSc、MEWSd在内外科患者之间无统计学差异(P均>0.05)。结论MEWS评分可以替代APACHEⅡ评分应用于临床,以识别危重症患者。其中MEWSc评分可能是广泛适用于内外科患者较好的评分,判别危重症的阈值≥3分,特异度为85.5%,灵敏度为74.3%,参数组成包括收缩压、心率、呼吸频率、意识水平、体温、呼吸支持6个参数。

Objective To study the clinical value of Modified Early Warning score(MEWS)in evaluating developing critical illness.Methods 360 death cases of inpatient with complete clinical data were analyzed.The clinical data include gender,age,life signs,respiratory support,Oxygen Saturation,consciousness,urinary output,results of chemical examination,diagnosis,and so on.Four different MEWS were created with different parameters combinations,namely MEWSa,MEWSb,MEWSc,MEWSd.MEWS and APACHE II score were evaluated at the 360 death cases.The correlation between 4 different MEWS and APACHE II score and the difference between 4 different MEWS were explored according to statistical analyses of correlation analysis,ROC curve and K Independent Samples Test.Results Four different MEWS score were positively correlate with APACHE II score,(P all<0.001).The optimal severe-illness-identification cutoff level of MEWSa,MEWSb,MEWSc,MEWSd was 3.The nonparametric test results with several independent samples show that MEWSa,MEWSc,MEWSd have no statistical significant variation between medical and surgery department.(P all>0.05).Conclusion MEWS may take the place of APACHE II,and it can be used to discriminate severity patients.MEWSc can be applicable for patients in medical and surgical department.The parameter group contains systolic pressure,heart rate,respiratory rate,consciousness level,body temperature,respiratory suppor.The severe-illness cutoff level≥3,The sensitivity was85.5%and specificity was 74.3%.