發(fā)布時間：2018-05-20 00:29

  本文選題：MEWS + APACHE　； 參考：《新疆醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：評價改良早期預(yù)警評分(Modified early warning score, MEWS)預(yù)測急診內(nèi)科成人患者去向和預(yù)后的效力,探討MEWS評分在臨床應(yīng)用的可行性,從而為急診工作人員快速評估患者病情狀況,合理分流、監(jiān)護(hù)患者提供科學(xué)參考。方法：選取2014年1月至2014年3月期間在新疆某三級甲等醫(yī)院急門診內(nèi)科就診的成年患者為研究對象,進(jìn)行前瞻性調(diào)查。記錄急門診內(nèi)科就診,符合納入排除標(biāo)準(zhǔn)的研究對象入急診時的首次體溫、收縮壓、心率、呼吸頻率和意識狀況,并進(jìn)一步追蹤患者的去向——是否入住急診內(nèi)科重癥監(jiān)護(hù)病房(Intensive care unit, ICU),出院時的預(yù)后狀況——是否死亡,對入院24小時及以上,具有急性生理與慢性健康評價(Acute physiology and chronic health evaluation, APACHEⅡ)的患者記錄其APACHEⅡ分值。根據(jù)患者的去向?qū)⒒颊叻譃榧痹\內(nèi)科ICU組和非急診內(nèi)科ICU組,根據(jù)患者預(yù)后將患者分為死亡組、存活組,根據(jù)APACHEⅡ評分將患者病情劃分為三個等級。利用受試者操作特征曲線下面積(The area under the receiver operating characteristic cure, AUROCC)評價MEWS評分的評估能力,根據(jù)約登指數(shù)確定MEWS評分的評價標(biāo)準(zhǔn),通過篩檢評價指標(biāo),靈敏度、特異度、陽性預(yù)測值、陰性預(yù)測值,符合率,對MEWS評分的判定結(jié)果進(jìn)行分析。一般結(jié)果：1)總體情況：本研究共調(diào)查1000人,MEWS評分平均(3.24±2.05)分。其中共640人具有APACHEⅡ評分,APACHEⅡ評分平均(14.29±6.51)分；2)不同性別,不同民族急診內(nèi)科成年患者的MEWS評分之間比較差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)；3)比較MEWS評分與增加年齡因素后的MEWS評分評估患者去向的AUROCC,兩曲線下面積差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。比較MEWS評分與增加年齡因素后的MEWS評分預(yù)測患者預(yù)后的AUROCC,兩曲線下面積差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)；4)嚴(yán)重病組患者M(jìn)EWS評分分值高于重病組患者,重病組患者的MEWS評分分值高于輕中病組,三組間MEWS評分分值差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；5)MEWS評分與患者去向、預(yù)后、病情、APACHE II評分分值均呈正相關(guān),相關(guān)系數(shù)分別為0.300、0.640、0.580、0.634；6)急診內(nèi)科ICU組患者M(jìn)EWS評分分值高于非急診內(nèi)科ICU組,兩組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05),死亡組患者M(jìn)EWS評分分值高于存活組,兩組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；7)MEWS評分評估患者去向的AUROCC為0.67,靈敏度是55.90%,特異度是71.80%,約登指數(shù)為0.28,陽性預(yù)測值54.90%,陰性預(yù)測值72.70%,符合率65.80%,MEWS評分評估患者去向的最佳截?cái)嘀凳?分,MEWS評分≥4分的患者病情嚴(yán)重；8)MEWS評分預(yù)測患者預(yù)后的AUROCC為0.96,靈敏度是95.50%,特異度是90.00%,約登指數(shù)為0.86,陽性預(yù)測值48.00%,陰性預(yù)測值99.50%,符合率90.50%,MEWS評分預(yù)測患者預(yù)后的最佳截?cái)嘀凳?分,MEWS評分≥7分的患者死亡風(fēng)險大；9)比較MEWS評分與APACHEⅡ評分評估患者去向的AUROCC,差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。比較MEWS評分與APACHEⅡ評分預(yù)測患者預(yù)后的AUROCC,差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)；10)將MEWS評分劃分為0～3分、4～6分和7～14分三個分值段。分值段越高,患者的急診內(nèi)科ICU入住率越高,三個分值段之間急診內(nèi)科ICU入住率比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。分值段越高,患者的死亡率越高,三個分值段之間患者死亡率比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：1) MEWS評分可用于評估不同性別、年齡、民族的急診內(nèi)科成年患者；2)MEWS評分可用于評估急診內(nèi)科患者的去向、預(yù)測患者預(yù)后,MEWS評分越高,患者的病情越嚴(yán)重,入住急診內(nèi)科ICU的風(fēng)險越大,預(yù)后越差；3)MEWS評分評估急診內(nèi)科患者去向的最佳截?cái)嘀凳?分,預(yù)測急診內(nèi)科患者預(yù)后的最佳截?cái)嘀凳?分；4)MEWS評分與APACHEⅡ評分對急診內(nèi)科患者去向具有中等預(yù)測價值,APACHEⅡ評分的評價效力稍高。MEWS評分對急診內(nèi)科患者預(yù)后具有較高的預(yù)測價值,APACHEⅡ評分對急診內(nèi)科患者預(yù)后具有中等預(yù)測價值,MEWS評分的評價效力較局。
[Abstract]:Objective: To evaluate the effectiveness of the improved early warning score (Modified early warning score, MEWS) to predict the direction and prognosis of adult patients in emergency internal medicine, and to explore the feasibility of MEWS score in clinical application, so as to provide emergency staff with rapid assessment of patient's condition, reasonable flow of flow, and a scientific reference for monitoring patients. Method: 1 in 2014. During the period from month to March 2014, a prospective investigation was conducted in the medical department of a three grade three class a hospital. A prospective investigation was conducted. The medical treatment in the emergency clinic was recorded. The first body temperature, systolic pressure, heart rate, respiratory frequency and consciousness were observed in the emergency clinic. Whether or not to stay in the emergency internal medicine, Intensive care unit (ICU), the prognosis of the hospital at discharge - whether death, 24 hours to the hospital and above, patients with acute physiological and chronic health assessment (Acute physiology and chronic health evaluation, APACHE II) recorded their APACHE II scores. The patients were divided into the emergency internal medicine ICU group and the non emergency internal medicine ICU group. The patients were divided into the death group according to the prognosis of the patients. The survival group was divided into three grades according to the APACHE II score. The evaluation score was evaluated using the area under the subject operating characteristic curve (The area under the receiver operating characteristic cure, AUROCC). The evaluation criteria of the MEWS score were determined according to the Joseph's index. Through the screening evaluation index, sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate, the results of MEWS score were analyzed. General results: 1) the overall situation: This study investigated 1000 people, and the MEWS score was average (3.24 + 2.05). Among them, there were 640 people. With APACHE II score, APACHE II score was average (14.29 + 6.51); 2) there was no statistically significant difference between MEWS scores of adult patients in different nationalities (P0.05); 3) compared the MEWS score and the MEWS score after increasing age factors to evaluate the patient's AUROCC, and the difference in area under the two curve was not unified. Study significance (P0.05). Compared with the MEWS score after MEWS score and age increasing, the prognosis of patients was predicted by AUROCC, and the area difference under the two curve was not statistically significant (P0.05); 4) the score of MEWS score in the patients with severe disease was higher than that in the severe disease group, and the score of the MEWS score in the severe disease group was higher than that in the light medium disease group, and the score of the MEWS score was poor between the three groups. The difference had statistical significance (P0.05); 5) MEWS score was positively correlated with the patient's direction, prognosis, condition, APACHE II score score, the correlation coefficient was 0.300,0.640,0.580,0.634; 6) the score of MEWS score in group ICU patients was higher than that of non emergency internal medicine ICU group, the difference between the two groups was statistically significant (P0.05) and the MEWS score of the death group. The difference between the two groups was statistically significant (P0.05); 7) the MEWS score was 0.67, the sensitivity was 0.67, the sensitivity was 55.90%, the specificity was 71.80%, the index was 0.28, the positive predictive value was 54.90%, the negative predictive value was 72.70%, the coincidence rate was 65.80%, and the best cut-off value of the MEWS score was 4, MEWS score. The patients with more than 4 points were seriously ill; 8) the prognosis of the patients with MEWS score was 0.96, the sensitivity was 95.50%, the specificity was 90%, the ratio was 0.86, the positive predictive value was 48%, the negative predictive value was 99.50%, the coincidence rate was 90.50%, the best cut-off value of the prognosis of the patient was 7, the MEWS score was greater than 7, and 9) was higher than that of 0.96. 9) ratio The difference between the MEWS score and the APACHE II score was not statistically significant (P0.05). The difference between the MEWS score and the APACHE II score for predicting the prognosis of the patients was not statistically significant (P0.05); 10) the MEWS score was divided into 0~3 points, 4~6 points and 7~14 points, and three segments. The higher the score, the patient's urgency was higher. The higher the occupancy rate of ICU in the medical department, the difference of ICU occupancy rate in the emergency internal medicine between the three segments was statistically significant (P0.05). The higher the score segment, the higher the mortality rate, the difference between the three segments of the patients was statistically significant (P0.05). Conclusion: 1) the MEWS score could be used to assess the gender, age, and nationality. Emergency internal medicine adult patients; 2) MEWS score can be used to assess the direction of patients in the emergency internal medicine, predict the patient's prognosis, the higher the MEWS score, the more serious the patient's condition, the greater the risk of ICU, the worse the prognosis; the best truncation value of the MEWS score is 4, and the prognosis of the patient is the most. The good truncation value is 7 points; 4) MEWS score and APACHE II score have medium predictive value for patients in the emergency internal medicine. The evaluation effect of APACHE II score is slightly higher than that of.MEWS score, which has a high predictive value for the prognosis of the patients in the emergency internal medicine. The APACHE II score has a moderate predictive value for the prognosis of the patients and the evaluation effect of the MEWS score. Compared to the Bureau.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R472.2
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本文編號：1912386