改良早期预警评分对重症急性胰腺炎并发急性肺损伤患者病情评估和预后的预测价值
|
摘要
目的:探讨改良早期预警评分(MEWS)对重症胰腺炎并发急性肺损伤患者病情评估和预后的预测价值。方法:选取我院147例重症急性胰腺炎患者进行回顾性研究,患者入院后详细记录第一次生命体征数据和急性生理学等指标,根据其结果计算MEWS评分及APACHEⅡ评分,根据是否发生ALI将患者分成发生肺损伤组(APALI组)和未发生肺损伤组(Non-APALI组),比较两组MEWS评分和APACHEⅡ评分的差异。采用Spearman检验进行两种评分相关性的分析。绘制受试者工作曲线(ROC)评价MEWS评分对患者APALI发生、入住ICU、死亡的预测价值。结果:APALI组及Non-APALI组的MEWS评分及APACHEⅡ评分比较差异具有统计学意义(P<0.05)。MEWS评分与APACHEⅡ评分呈一元线性相关:Y(MEWS)=0.220+0.317X(APACHEⅡ),相关系数r=0.716,Pearson检验P<0.01。MEWS评分与氧合指数(PO2/FiO2)的关系同样发现呈一元线性相关:Y(MEWS)=11.17+(-0.026)X(PO2/FiO2),相关系数r=-0.674,Pearson检验P<0.01。MEWS预测APALI发生、ICU住院、死亡事件的曲线下面积分别为:0.912(95%CI:0.862～0.963)、0.932(95%CI:0.890～0.975)、0.967(95%CI:0.929～1.005),截断点分别为3.5分、4.5分及6.5分,具有良好预测价值。结论:MEWS评分与APACHEⅡ均适合重症胰腺炎并发急性肺损伤患者病情评估和预后的预测,但MEWS更易操作、节省时间,便于对此类患者中应用,甚至可推广应用于急诊室急危重症患者。
Objective:To discuss The value of modified early warning score(MEWS)in condition assessment and prognosis of Acute Pancreatitis Associated Lung Injury.Method:This retrospective study included 147 patients with severe acute pancreatitis in our hospital.We recorded the first vital data and acute physiology indexes,and calculated MEWS score and APACHE Ⅱ.We divided the all patients into two groups:group APALI and group Non-APALI.MEWS score and APACHE Ⅱscore were compared between two groups.Spearman test was used to analyze the correlation between the two scores.The receiver operating characteristic curve(ROC)was used to evaluate the predictive value of MEWS score on APALI occurrence,ICU admission and death of patients.Result:The differences of MEWS score and APACHE Ⅱscore in two groups had statistical significance(P<0.05).The MWES was correlated with APACHE II score,Y(MEWS)=0.220+0.317 X(APACHE Ⅱ),(r=0.716,P<0.01).The MWES was also correlated with Oxygenation index,Y(MEWS)=11.17+(-0.026)X(PO2/FiO2)(r=-0.674,P<0.01).The area under ROC curve of the MEWS for APALI occurrence,ICU admission and mortality predictive value were 0.912(95%CI:0.862-0.963),0.932(95%CI:0.890-0.975),0.967(95%CI:0.929-1.005),Cut-off points were 3.5,4.5 and 6.5.Conclusion:MEWS score and APACHEⅡscore are suitable for assessment and prognosis prediction of severe pancreatitis complicated with acute lung injury,but MEWS is simple,and easy to obtain paramters and saving time,it is convenient for use MEWS to evaluate patiens in Emergence Room.
Objective:To discuss The value of modified early warning score(MEWS)in condition assessment and prognosis of Acute Pancreatitis Associated Lung Injury.Method:This retrospective study included 147 patients with severe acute pancreatitis in our hospital.We recorded the first vital data and acute physiology indexes,and calculated MEWS score and APACHE Ⅱ.We divided the all patients into two groups:group APALI and group Non-APALI.MEWS score and APACHE Ⅱscore were compared between two groups.Spearman test was used to analyze the correlation between the two scores.The receiver operating characteristic curve(ROC)was used to evaluate the predictive value of MEWS score on APALI occurrence,ICU admission and death of patients.Result:The differences of MEWS score and APACHE Ⅱscore in two groups had statistical significance(P<0.05).The MWES was correlated with APACHE II score,Y(MEWS)=0.220+0.317 X(APACHE Ⅱ),(r=0.716,P<0.01).The MWES was also correlated with Oxygenation index,Y(MEWS)=11.17+(-0.026)X(PO2/FiO2)(r=-0.674,P<0.01).The area under ROC curve of the MEWS for APALI occurrence,ICU admission and mortality predictive value were 0.912(95%CI:0.862-0.963),0.932(95%CI:0.890-0.975),0.967(95%CI:0.929-1.005),Cut-off points were 3.5,4.5 and 6.5.Conclusion:MEWS score and APACHEⅡscore are suitable for assessment and prognosis prediction of severe pancreatitis complicated with acute lung injury,but MEWS is simple,and easy to obtain paramters and saving time,it is convenient for use MEWS to evaluate patiens in Emergence Room.
引文
[1]Subbe CP,Kruger M,Rutherford P,et al.Validation of a modifled early warning score in medical admissions[J].QJM,2001,94(10):521-526.
[2]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华肝胆外科杂志,2015,21(1):1-4.
[3]中华医学会重症医学分会.急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)[J].中国危重病急救医学,2006,18(12):706-710.
[4]Griffiths JR,Kidney EM.Current use of early warning scores in UK emergency departments[J].Emerg Med J,2012,29(1):65-66.
[5]Ruan H,Zhu Y,Tang Z,et al.Modified early warning score in assessing disease conditions and prognosis of10,517pre-hospital emergency cases[J].Int J Clin Exp Med,2016,9(7):1455414558.
[6]陈华,刘海华,张晓毳,等.改良早期预警评分在评估急诊外科患者病情及预后中的作用[J].临床急诊杂志,2015,16(3):189-191,194.
[7]方婷婷,李萍,肖江琴,等.改良早期预警评分在急诊胸痛患者中的应用[J].实用医学杂志,2016,32(2):315-317.
[8]王建岗,周梅亚,徐卫华等.改良早期预警评分能够识别院前危重症患者及预测死亡风险[J].中华急诊医学杂志,2016,25(8):1089-1092.
[9]方婷婷,肖江琴,李萍.改良早期预警评分对重症肺炎患者病情评估和预后预测的价值[J].中国急救医学,2015,35(8):719-721.
[10]熊明英.改良早期预警评分与APACHEⅡ预测急诊室患者病情的效果分析[J].临床急诊杂志,2015,16(10):798-800.
[11]Petraschka M,Gilbert T,Westenbroek R,et al.Validation of a Modified Early Warning Score(MEWS)in emerency department observation ward patients[J].J Pain,2006,13(Suppl 1):24-30.
[12]周永江.改良早期预警评分在急性脓毒症患者预后中的应用价值[J].实用医院临床杂志,2017,14(3):98-100.
[13]Armagan E,Yilmaz Y,Olmez OF,et al.Predictive value of the modified Early Warning Score in a Turkish emergency department[J].Eur J Emerg Med,2008,15(6):338-340.
[14]Bulut M,Cebicci H,Sigirli D,et al.The comparison of modified early warning score with rapid emergency medicine score:aprospective muhicentre observational cohort study on medical and surgical patients presenting to emergency department[J].Emerg Med J,2014,31(6):476-481.
[15]Cattermole GN,Mak SK,Liow CH,et al.Derivation of aprognostic score for identifying critically ill patients in an emergency department resuscitation room[J].Resuscitation,2009,80(9):1000-1005.
[16]王长远,曹涛,汤辉,等.NEWS评分MEWS评分和APACHE II评分对急诊内科抢救室患者的评估价值[J].中国急救医学,2017,37(2):123-126.
[17]任艺,邵旦兵,刘红梅,等.MEWS评分SCS评分和APACHElI评分在评估急诊危重患者预后中的作用[J].中国急救医学,2013,33(8):711-714.
[2]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华肝胆外科杂志,2015,21(1):1-4.
[3]中华医学会重症医学分会.急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)[J].中国危重病急救医学,2006,18(12):706-710.
[4]Griffiths JR,Kidney EM.Current use of early warning scores in UK emergency departments[J].Emerg Med J,2012,29(1):65-66.
[5]Ruan H,Zhu Y,Tang Z,et al.Modified early warning score in assessing disease conditions and prognosis of10,517pre-hospital emergency cases[J].Int J Clin Exp Med,2016,9(7):1455414558.
[6]陈华,刘海华,张晓毳,等.改良早期预警评分在评估急诊外科患者病情及预后中的作用[J].临床急诊杂志,2015,16(3):189-191,194.
[7]方婷婷,李萍,肖江琴,等.改良早期预警评分在急诊胸痛患者中的应用[J].实用医学杂志,2016,32(2):315-317.
[8]王建岗,周梅亚,徐卫华等.改良早期预警评分能够识别院前危重症患者及预测死亡风险[J].中华急诊医学杂志,2016,25(8):1089-1092.
[9]方婷婷,肖江琴,李萍.改良早期预警评分对重症肺炎患者病情评估和预后预测的价值[J].中国急救医学,2015,35(8):719-721.
[10]熊明英.改良早期预警评分与APACHEⅡ预测急诊室患者病情的效果分析[J].临床急诊杂志,2015,16(10):798-800.
[11]Petraschka M,Gilbert T,Westenbroek R,et al.Validation of a Modified Early Warning Score(MEWS)in emerency department observation ward patients[J].J Pain,2006,13(Suppl 1):24-30.
[12]周永江.改良早期预警评分在急性脓毒症患者预后中的应用价值[J].实用医院临床杂志,2017,14(3):98-100.
[13]Armagan E,Yilmaz Y,Olmez OF,et al.Predictive value of the modified Early Warning Score in a Turkish emergency department[J].Eur J Emerg Med,2008,15(6):338-340.
[14]Bulut M,Cebicci H,Sigirli D,et al.The comparison of modified early warning score with rapid emergency medicine score:aprospective muhicentre observational cohort study on medical and surgical patients presenting to emergency department[J].Emerg Med J,2014,31(6):476-481.
[15]Cattermole GN,Mak SK,Liow CH,et al.Derivation of aprognostic score for identifying critically ill patients in an emergency department resuscitation room[J].Resuscitation,2009,80(9):1000-1005.
[16]王长远,曹涛,汤辉,等.NEWS评分MEWS评分和APACHE II评分对急诊内科抢救室患者的评估价值[J].中国急救医学,2017,37(2):123-126.
[17]任艺,邵旦兵,刘红梅,等.MEWS评分SCS评分和APACHElI评分在评估急诊危重患者预后中的作用[J].中国急救医学,2013,33(8):711-714.