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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 investigate the prognostic value of modified early warning score (MEWS) system in the prognosis of senile shock in elderly shock patients admitted to the Emergency Department of West China Hospital, Sichuan University. Methods: A retrospective analysis of 118 senile shock patients enrolled in 2013-01-2014-01 was performed. MEWS score, shock index, APACHEⅡscore and SOFA score of each patient were calculated. The main clinical diagnostic criteria (sensitivity, specificity, accuracy, positive predictive value, and negative predictive value) of the MEWS system and the current three general scoring systems (shock index, APACHE II score, SOFA score) were estimated by the software SPSS and MedCalc ROC curves of each scoring system were drawn to analyze the advantages of MEWS scoring system in predicting the prognosis of elderly patients with shock. Results: Among 118 elderly patients with shock, 25 died and the case fatality rate was 21.2%. From the ROC curve analysis, the area under the curve of shock index, APACHEⅡscore, SOFA score and MEWS score were 0.781,0.917,0.598,0.721 respectively. Among them, there was no significant difference between the shock index and the MEWS score, the SOFA score and the MEWS, the area under the shock index and the SOFA curve, while the other two groups showed statistically significant differences (P <0.05). The sensitivity of MEWS was 56%, which was significantly better than that of SOFA (32%) (P <0.05), but not significantly different from that of shock (57.14%). The specificity of MEWS was 79.6% 92.39%). There was no significant difference with the index of shock (80.7%) and APACHEⅡ (86.49%). Conclusion: MEWS scoring system predicts the prognosis of senile shock patients with high accuracy, and has the advantages of simple, quick, easy to grasp, not limited by many hardware devices, etc. In the clinical application of rapid assessment of the condition of elderly shock patients, obvious advantage.