国家早期预警评分在肿瘤危重症患者病情评估中的应用

Performance of National Early Warning Score in Assessment of Critical Cancer Patients

目的:探讨国家早期预警评分(National Early Warning Score,NEWS)在肿瘤危重症患者病情评估的应用价值。方法:采用前瞻性队列研究设计,连续收集2016年1月至2019年6月我院行外科手术后的肿瘤危重症患者325例,现场收集患者病史资料及急诊数据,追踪患者实际转归及预后情况,按预后分为死亡组和存活组,依据NEWS评分系统对两组患者进行NEWS评分及危险度分级,比较两组患者NEWS评分情况,采用多因素Logistic回归模型分析NEWS危险度分级预测肿瘤危重症患者转归和预后的能力。结果:死亡组患者平均年龄、急性生理学及慢性健康评估系统Ⅱ评分、NEWS评分均高于存活患者,格拉斯哥昏迷指数评分低于存活患者,差异均有统计学意义(均P<0.05)。死亡组患者经NEWS评分判定为极高危患者所占比例最高(50.0%)、其次为中危(23.1%),而高危及以上合计占65.4%,存活组患者里,低危患者所占比例最多(58.9%)、其次中危和高危,两组患者危险度分级构成之间差异有统计学意义(P<0.001)。随着NEWS评分危险度分级的增加肿瘤危重症患者的死亡率也随着增加,呈明显增长趋势,差异有统计学意义(趋势χ^2=52.287,P<0.001)。NEWS评分危险度分级与肿瘤危重症患者死亡风险相关性分析显示:NEWS评分评定为中危、高危和极高危的肿瘤危重症患者与30 d内死亡存在显著的正相关关系,是预后死亡的高危人群;中危、高危和极高危肿瘤危重症患者30 d死亡风险分别是低危患者死亡风险的4.577倍、8.802倍和53.571倍。结论:NEWS评分系统可以较好地评估外科手术后的肿瘤危重症患者预后,根据NEWS总评分划分为不同风险等级,可以量化、分类肿瘤危重症患者的死亡风险。

Objective:To verify the performance of National Early Warning Score(NEWS)in the assessment of critical cancer patients.Methods:A prospective cohort study was designed to collect 325 cases of critical cancer patients admitted to our hospital from January 2016 to June 2019 as research objects.We collected the clinical data and emergency data of the patients,followed up their actual outcomes,and assigned them to the death group and the survival group accordingly.The two groups of patients were assessed by using NEWS,and NEWS in two groups were compared.Logistic regression model was used to analyZe the correlation between the risk classification(NEWS)and the risk of death in critical cancer patients.Results:The average age,Acute Physiology and Chronic Health Evaluation II score and NEWS in the death group were significantly higher than those in the survival group(P<0.05),and the GCS score in the former was significantly lower than that in the latter(P<0.05).In the death group,the proportion of NEWS-defined extremely high risk patients and medium risk patients were 50.0%(rank first)and 23.1%(rank second);high and extremely high risk patients accounted for 65.4%of the total.In the survival group,the proportion of low risk patients was the highest(58.9%),followed by middle and high risk patients.There was statistically significant difference between the two groups in risk classification(P<0.001).The mortality in critical cancer patients increased significantly as NEWS increased(χ^2=52.287,P<0.001).The correlation analysis showed that death within 30 days was positively correlated to NEWS-defined medium,high and extremely high risk patients which were at high risk for death;and the 30-day mortality of medium,high and extremely high risk patients were 4.577 times and times 8.802 and 53.571 times as much as low risk patients.Conclusion:NEWS scoring system can better assess the prognosis of critical cancer patients after surgery.Risk classification divided by the total score of NEWS can quantify and classify the risk of death in critical cancer patients.