摘要
目的:以四川大学华西医院急诊科收治的老年休克患者为数据来源,探讨改良早期预警评分(MEWS)系统对老年休克患者预后的预测价值。方法:回顾性分析2013-01-2014-01纳入的老年休克患者118例,计算每位患者的MEWS评分、休克指数,APACHEⅡ评分和SOFA评分。通过SPSS、MedCalc软件估算MEWS系统与当前三大常规评分体系(休克指数、APACHEⅡ评分、SOFA评分)的主要临床诊断指标(敏感度、特异度、准确度、阳性预测值和阴性预测值),并绘制各评分系统的ROC曲线,来分析MEWS评分系统在老年休克患者预后预测中的优势。结果:118例老年休克患者,死亡25例,病死率21.2%。由ROC曲线分析得出休克指数、APACHEⅡ评分、SOFA评分、MEWS评分的曲线下面积分别为0.781、0.917、0.598、0.721。其中,休克指数与MEWS评分、SOFA评分与MEWS、休克指数与SOFA曲线下面积差异无统计学意义,而其余两两之间的差异有统计学意义(P<0.05)。MEWS的灵敏度是56%,明显优于SOFA评分(32%)(P<0.05),但是与休克指数(57.14%)差异无统计学意义;MEWS的特异度是79.6%,略差于SOFA评分(92.39%),与休克指数(80.7%)、APACHEⅡ评分(86.49%)差异无统计学意义。结论:MEWS评分系统预测老年休克患者预后的准确性较高,且具有操作简便、快捷,易于掌握,不受许多硬件设备条件限制等优点,在对快速评估老年休克患者病情的临床应用中,具有明显的优势。
Objective：To evaluate the predictive value of the modified early warning score （MEWS） system for prognostic of elderly patients with shock in the department of Emergency of West China Hospital,Sichuan University. Method：The retrospective study was used, and 118 elderly patients with shock were included from January 2013 to January 2014. The MEWS score, shock index, APACHE Ⅱ score and SOFA score were calculated. The SPSS and MedCalc software were used to calculate the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the four scoring systems,and to draw the ROC curve of each scoring system to evaluate the predictive value of the modified early warning score （MEWS） system for prognostic of elderly patients with shock. Result： One hundred and eighteen cases were included, mortality rate was 21.2%（25 death cases）. The are- as under the curves of shock index, APACHE Ⅱ score, SOFA score and MEWS score were 0. 781,0.971,0. 598 and 0.721, respectively. There were no significant differences in the area under the curves between shock index and MEWS score,between SOFA score and MEWS,and between shock index and SOFA curve, but there was signifi- cant difference between the other two groups （P〈0.05）. The sensitivity of MEWS was 56 %, significantly better than SOFA score （32%） ,there is significant differences between the two scores （P〈0.05）. But there is no signifi cant differences between the MEWS and the shock index. The specificity of MEWS was 79.6%,The specificity of SOFA is better than MEWS, but there is no significant difference in specificity between the MEWS and the shock index, and between the MEWS and APCHE ]I. Conclusion：The predictive value of the modified early warning score （MEWS） system for prognostic of elderly patients with shock is higher than other score system, MEWS scoring system has many advantages, such as simple,fast, easy to master, not subject to many hardware equipment conditions, etc,so it has a clear advantage in the clinical application of rapid assessment of the condition for elderly pa- tients with shock.
作者
梁镰静
秦溱
胡海
李东泽
曹钰
LIANG Lianjing QIN Qin HU Hai LI Dongze CAO Yu(Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, China)
出处
《临床急诊杂志》
CAS
2017年第3期208-212,216,共6页
Journal of Clinical Emergency
基金
卫生部公益性行业科研专项(No:201302003)
四川省卫生计生委资助项目(No:150169)
作者简介
通信作者：曹钰，E-mail：yuyuer@126．com
