改良早期预警评分与校正改良早期预警评分预测普外科术后患者去向的应用价值

Application value of MEWS and corrected MEWS in predicting where postoperative patients of General Surgery Department will go

目的探讨改良早期预警评分(MEWS)与校正MEWS预测普外科术后患者去向的应用价值。方法采用便利抽样法,选取2017年1月-2018年12月上海市浦东新区公利医院普外科术后1160例患者,收集患者转入病房72 h内的生命体征、神志、血氧饱和度及尿量数据,使用MEWS和校正MEWS分别评估。计算该期间两种评分的最高评分结果,观察患者的去向。比较两种评分预测患者去向的相关预测指标灵敏度、特异度、阳性预测值、阴性预测值、预测患者去向分辨度的受试者工作特征曲线(ROC)。结果转入ICU患者的校正MEWS高于MEWS。以收住ICU为预测目标时,MEWS的ROC曲线下面积为0.986(95%CI为0.973~0.998),最佳截断值为3分,此时Youden指数最大,为0.903;校正MEWS的ROC曲线下面积为0.991(95%CI为0.978~0.995),最佳截断值是5分,此时Youden指数最大,为0.943;校正MEWS的ROC曲线下面积大于MEWS,差异有统计学意义(P<0.05);校正MEWS评估患者转入ICU的特异度、阳性预测值高于MEWS,差异有统计学意义(P<0.05);校正MEWS评估患者转入ICU的灵敏度、阴性预测值高于MEWS,但差异无统计学意义(P>0.05)。结论校正MEWS比MEWS更能反映外科术后患者病情危重程度,能够准确预测患者的病情变化,值得在普外科病房中推广应用。

Objective To explore the application value of Modified Early Waring Score(MEWS)and corrected MEWS in predicting where postoperative patients of General Surgery Department will go.Methods From January 2017 to December 2018,a total of 1160 postoperative patients of General Surgery Department at Shanghai Pudong New Area Gongli Hospital were selected by convenience sampling.Data of patients were selected including the vital signs of patients within 72 hours after transferring to wards,consciousness,oxygen saturation and urine volume.Patients were evaluated with the MEWS and the corrected MEWS respectively.This study calculated the highest scores of those two tools and observed that where patients would go.This study also compared the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and receiver operating characteristic(ROC)curve of resolution which predicted where patients would go between the two scores.Results The scores of corrected MEWS of patients transferring to Intensive Care Unit(ICU)were higher than those of MEWS.When taking being admitted to ICU as the predicted target,area under ROC curve of MEWS was 0.986(95%CI:0.973-0.998)and the best cutoff value was 3 with 0.903 for the maximum Youden index at this moment;area under ROC curve of corrected MEWS was 0.991(95%CI:0.978-0.995)and the best cutoff value was 5 with 0.943 for the maximum Youden index at this moment.The area under ROC curve of corrected MEWS was greater than that of MEWS with a statistical difference(P<0.05);the specificity and PPV which evaluated that patients were admitted to ICU by corrected MEWS were higher than those by MEWS with statistical differences(P<0.05);the sensitivity and NPV which evaluated that patients were admitted to ICU by corrected MEWS were higher than those by MEWS with no statistical differences(P>0.05).Conclusions Compared with MEWS,the corrected MEWS could reflect condition severity of postoperative patients of General Surgery Department better and correctly predict patient's conditions which is worthy of being popularized and applied in General Surgery.