改良早期预警评分与急性生理和慢性健康评分系统对急诊内科患者病情的评估作用

Effect of Modified Early Warning Score and Acute Physiological and Chronic Health score System on Disease Evaluation of Patients in Emergency medical Department

目的探讨改良早期预警评分与急性生理和慢性健康评分系统对急诊内科患者病情评估作用。方法回顾性分析2016年1月至2018年12月在上海市闵行区中心医院急诊科治疗的80例胃肠疾病患者的临床资料,均行择期胃肠道手术,根据补液的速度和剂量不同分为两组,每组40例。对照组采用输液的速度和剂量是维持心率和收缩压不低于术前的20%,尿量不少于0.5 mL/(kg·h);观察组采用补液时10 min B超测一次IVC宽度,如IVC<15 mm,RVI大于50%,快速补液,如IVC>20 mm,RVI<50%,停止快速补液,仅给生理需要量。采用改良早期预警评分(MEWS)和急性生理和慢性健康评分系统(APACHEⅡ)进行病情评估。结果观察组的MEWS评分和APACHEⅡ评分明显低于对照组(P<0.05);APACHEⅡ评分的灵敏度高于MEWS评分,而MEWS评分的特异性和阳性预测值高于APACHEⅡ评分(P<0.05)。结论MEWS和APACHEⅡ均对急诊内科患者病情评估有良好预测作用,临床可联合APACHEⅡ评分和MEWS评分共同评估,以提高病情评估的灵敏度、特异性。

Objective To explore the effect of improved early warning score and acute physiological and chronic health score system on the disease evaluation of patients in emergency medical department.Methods The clinical data of 80 patients with gastrointestinal diseases treated in emergency department of Shanghai Minhang District Central Hospital from January 2016 to December 2018 were retrospectively analyzed.all patients underwent elective gastrointestinal surgery.The patients were divided into two groups according to the speed and dose of rehydration.In the control group,the rate and dose of infusion were not less than 20%of the preoperative heart rate and systolic blood pressure,and the urine volume was not less than 0.5 mL/(kg·h).In that observe group,the width of IVC was measured once in 10 minute by B-ultrasound,such as IVC<15 mm,RVI>50%,rapid fluid replacement,such as IVC>20 mm,RVI<50%,stop rapid fluid replacement,Only the physiological requirements are given.A modified early warning score(MEWS)and an acute physiological and chronic health score system(APACHEⅡ)were used to assess the severity of the disease.Results MEWS score and APACHEⅡscore in the observation group were significantly lower than those in the control group(P<0.05).The sensitivity of APACHEⅡscore was higher than that of MEWS score,while the specificity and positive predictive value of MEWS score were higher than that of APACHEⅡscore(P<0.05).Conclusion Both MEWS and APACHEⅡhave a good predictive effect on the evaluation of emergency medical patients,which can be combined with APACHEⅡscore and MEWS score to improve the sensitivity and specificity of the evaluation.