急性冠状动脉综合征患者心搏骤停前24 h早期预警评分变化趋势的研究
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摘要
目的探讨急性冠状动脉综合征(acute coronary syndromes,ACS)患者发生心搏骤停前24 h英国国家早期预警评分(National Early Warning Score,NEWS)的变化趋势。方法采取病例对照研究的方法,选取福建省3所三级甲等医院发生心搏骤停的ACS患者为病例组,随机选取未发生心搏骤停的ACS患者为对照组。分析心搏骤停发生前24 h各时间点两组之间NEWS分值的差异及24 h的变化趋势。结果在心搏骤停发生前24 h、16 h、8 h、1 h和0.5 h,两组之间的NEWS分值差异均具有统计意义,病例组均高于对照组,呈持续上升的趋势(P<0.001)。在病例组中,越接近心搏骤停的发生,高危组所占的比重从心搏骤停前24 h的11.6%升高至0.5 h前的36.6%,低危组所占的比重从心搏骤停前24 h的67.7%减少至0.5 h前的21.4%,而对照组无明显变化。从心搏骤停发生前24 h至0.5 h,高危组发生心搏骤停的概率是低危组的7.00倍逐渐上升至56.57倍。结论 NEWS能较好地预测心搏骤停的发生,应将NEWS应用于临床,识别发生心搏骤停潜在的高危患者。
Objective To explore trends of the National Early Warning Scores(NEWS) 24 h prior to in-hospital cardiac arrest(IHCA) for patients with acute coronary syndromes(ACS). Methods We conducted a retrospective case-control study in 3 tertiary hospitals in Fujian Province,patients with ACS who experienced cardiac arrest were in the case group. We randomly selected patients with ACS who had not experienced cardiac arrest as the control group. The NEWS was calculated at 24 h,16 h,8 h,1 h and 0.5 h before cardiac arrest and the trends were analyzed. Results The NEWS were significantly different between the case group and the control group at 24 h,16 h,8 h,1 h and 0.5 h before cardiac arrest,the scores in the case group were higher than those in the control group,and the trend was continuingly rising(P<0.001). The proportion of high-risk NEWS group was enlarged before cardiac arrest(from 24 h to 0.5 h,NEWS increased from 11.6% to 36.6%),and the proportion of low-risk NEWS group was smaller(from 24 h to 0.5 h,NEWS decreased from 67.7% to 21.4%). From 24 h to 0.5 h prior to cardiac arrest,compared to low-risk group,the incidence of cardiac arrest of high-risk group was increased from7.00 times to 56.57 times. Conclusion The NEWS can properly predict cardiac arrest among patients with ACS,and can better identify high-risk patients.
Objective To explore trends of the National Early Warning Scores(NEWS) 24 h prior to in-hospital cardiac arrest(IHCA) for patients with acute coronary syndromes(ACS). Methods We conducted a retrospective case-control study in 3 tertiary hospitals in Fujian Province,patients with ACS who experienced cardiac arrest were in the case group. We randomly selected patients with ACS who had not experienced cardiac arrest as the control group. The NEWS was calculated at 24 h,16 h,8 h,1 h and 0.5 h before cardiac arrest and the trends were analyzed. Results The NEWS were significantly different between the case group and the control group at 24 h,16 h,8 h,1 h and 0.5 h before cardiac arrest,the scores in the case group were higher than those in the control group,and the trend was continuingly rising(P<0.001). The proportion of high-risk NEWS group was enlarged before cardiac arrest(from 24 h to 0.5 h,NEWS increased from 11.6% to 36.6%),and the proportion of low-risk NEWS group was smaller(from 24 h to 0.5 h,NEWS decreased from 67.7% to 21.4%). From 24 h to 0.5 h prior to cardiac arrest,compared to low-risk group,the incidence of cardiac arrest of high-risk group was increased from7.00 times to 56.57 times. Conclusion The NEWS can properly predict cardiac arrest among patients with ACS,and can better identify high-risk patients.
引文
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[22]Smith GB.In-hospital cardiac arrest:is it time for an inhospital“chain of prevention”?[J].Resuscitation,2010,81(9):1209-1211.
[23]Jo S,Yoon J,Lee JB,et al.Predictive value of the National Early Warning Score-Lactate for mortality and the need for critical care among general emergency department patients[J].JCrit Care,2016,36(12):60-68.
[24]Brabrand M.Mobility measures should be added to the National Early Warning Score(NEWS)[J].Resuscitation,2014,85(9):e151.
[2]Nolan JP,Hazinski MF,Aickin R,et al.Part 1:executive summary:2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations[J].Resuscitation,2015,95(10):e1-e31.
[3]吴婷婷,李红.院内心搏骤停早期预警评分系统的研究进展[J].中华护理杂志,2016,51(9):1118-1123.
[4]Bossaert LL,Perkins GD,Askitopoulou H,et al.European Resuscitation Council Guidelines for Resuscitation 2015:Section11.The ethics of resuscitation and end of life decisions[J].Resuscitation,2015,95(10):302-311.
[5]Andersen LW,Kim WY,Chase M,et al.The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest[J].Resuscitation,2016,98(6):112-117.
[6]Soar J,Nolan JP,Bottiger BW,et al.European Resuscitation Council Guidelines for Resuscitation 2015:Section 3.Adult advanced life support[J].Resuscitation,2015,95(10):100-147.
[7]Royal College of Physicians.National Early Warning Score(NEWS):standardizing the assessment of acute-illness severity in the NHS.Report of a working party[R].London:Royal College of Physicians,2012.
[8]Smith GB,Prytherch DR,Meredith P,et al.The ability of the National Early Warning Score(NEWS)to discriminate patients at risk of early cardiac arrest,unanticipated intensive care unit admission,and death[J].Resuscitation,2013,84(4):465-470.
[9]Shao F,Li CS,Liang LR,et al.Incidence and outcome of adult in-hospital cardiac arrest in Beijing,China[J].Resuscitation,2016,102(5):51-56.
[10]陶贵周,姚书霞.2010年我国急性ST段抬高型心肌梗死诊断与治疗指南解读评析[J].医学与哲学(临床决策论坛版),2011,32(12):22-28.
[11]柯元南,陈纪林.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007,35(4):295-304.
[12]Churpek MM,Yuen TC,Edelson DP,et al.Risk stratification of hospitalized patients on the wards[J].Chest,2013,143(6):1758-1765.
[13]Churpek MM,Yuen TC,Park SY,et al.Using electronic health record data to develop and validate a prediction model for adverse outcomes in the wards[J].Crit Care Med,2014,42(4):841-848.
[14]Bartkowiak B,Snyder AM,Benjamin A,et al.Validating the Electronic Cardiac Arrest Risk Triage(eCART)Score for risk stratification of surgical inpatients in the postoperative setting:retrospective cohort study[J].Ann Surg,2018,1(12):1112-1116
[15]Roberts D,Djarv T.Preceding national early warnings scores among in-hospital cardiac arrests and their impact on survival[J].Am J Emerg Med,2017,35(11):1601-1606.
[16]Hole O,Li H,Shahidah N,et al.Poor performance of the Modified Early Warning Score for predicting mortality in critically ill patients presenting to an emergency department[J].World J Emerg Med,2013,4(4):273-278.
[17]Kim WY,Shin YJ,Lee JM,et al.Modified Early Warning Score changes prior to cardiac arrest in general wards[J].PLo S One,2015,10(6):e0130523.
[18]Suppiah A,Malde D,Arab T,et al.The Modified Early Warning Score(MEWS):an instant physiological prognostic indicator of poor outcome in acute pancreatitis[J].JOP,2014,15(6):569-576.
[19]Subbe CP,Kruger M,Rutherford P,et al.Validation of a Modified Early Warning Score in medical admission[J].QJM,2001,94(10):521-526.
[20]Kolic I,Crane S,Mccartney S,et al.Factors affecting response to National Early Warning Score(NEWS)[J].Resuscitation,2015,90(5):85-90.
[21]Smith GB,Prytherch DR,Jarvis S,et al.A comparison of the ability of the physiologic components of medical emergency team criteria and the UK National Early Warning Score to discriminate patients at risk of a range of adverse clinical outcomes[J].Crit Care Med,2016,44(12):2171-2181.
[22]Smith GB.In-hospital cardiac arrest:is it time for an inhospital“chain of prevention”?[J].Resuscitation,2010,81(9):1209-1211.
[23]Jo S,Yoon J,Lee JB,et al.Predictive value of the National Early Warning Score-Lactate for mortality and the need for critical care among general emergency department patients[J].JCrit Care,2016,36(12):60-68.
[24]Brabrand M.Mobility measures should be added to the National Early Warning Score(NEWS)[J].Resuscitation,2014,85(9):e151.