国家早期预警评分对不同证型急诊内科患者预后的预测价值比较

Predictive value of national early warning score for prognosis of patients with different syndromes in emergency internal medicine

目的:探讨国家早期预警评分(NEWS)对不同证型的急诊内科患者死亡等转归情况的预测价值,比较不同证型患者的NEWS。方法:收集从2017年1月至12月于中国中医科学院广安门医院急诊科留观、抢救室治疗的449例内科疾病患者的NEWS评分、转归情况及中医证型。结果:实证病死率和NEWS得分显著低于虚证和虚实夹杂证(P<0.05,P<0.01);虚证的病死率和NEWS得分显著低于虚实夹杂证(P<0.01);全部患者NEWS评分截断点为5.5分,该点时敏感度0.890、特异度0.688,各证型中NEWS评分也能很好地预测死亡(P<0.01)。NEWS<6分患者共334例,平均4分;NEWS≥6分患者28d病死数、转至重症监护病房(ICU、CCU)数均大于NEWS<6分患者(P<0.001,P<0.01)。结论:NEWS评分对不同证型患者预后、转归有很高的预测价值,可辅助医师对急救患者病情评估,预测住院的概率等。中医方面,实证患者NEWS评分最低,可考虑中病即止;虚证要徐徐进补;虚实夹杂证患者NEWS评分最高,需在积极"祛邪"的对症治疗基础上,重视贯彻"扶正"思想。

Objective: To explore the predictive value of the national early warning scoring system(NEWS) on the prognosis of death in emergency internal medicine with different traditional Chinese medicine(TCM) syndromes, and to compare the NEWS of patients with different TCM syndrome types. Methods: The NEWS scores, outcomes, and TCM syndrome types were collected from January 2017 to December 2017 in the resuscitation room of the emergency department of Guang’anmen Hospital of Chinese Academy of Traditional Chinese Medicine. Results: The actual case fatality rate and NEWS score of the excessive syndrome were lower than those of deficient syndrome, which had the difference of statistics(P<0.05);the fatality rate and NEWS score of deficiency syndrome group were lower than those of deficiency and excess syndrome group(P<0.05). The truncated point of NEWS score of all patients was 5.5 points, the sensitivity was 0.890 and the specificity was 0.688, and the NEWS score in each type could also predict the death(P<0.01). The patients with NEWS score less than 6 were 334 patients, with an average of 4 points The number of patients with NEWS score above 6 points in 28 days and the number of patients transferred to the intensive care unit(ICU, CCU) were all larger than those of NEWS score less than 6(P<0.001, P<0.01). Conclusion: The NEWS score had high predictive value for prognosis and outcome of patients with different syndromes. It could assist physicians in assessing the condition of emergency patients and predicting the probability of hospitalization. In traditional Chinese medicine, the NEWS score of patients with excess syndrome was the lowest, which could be considered as stopping treatment as soon as recover;the patients of deficiency syndrome should be gradually improved;the NEWS score of deficiency and excess syndrome patients was the highest, which should pay attention to the ‘strengthening the right’ thought based on ‘dispelling pathogens’.