改良早期预警评分对腹部闭合性创伤预后的预测价值
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摘要
目的观察改良早期预警评分(MEWS)用于腹部闭合性创伤评估的临床效果。方法收集2008年1月至2017年11月芜湖市第五人民医院收治的160例腹部闭合性创伤患者资料,回顾性分析并统计所有患者临床诊治及预后资料,采用MEWS评分系统进行评估,观察患者分诊情况(门诊或专科保守治疗、ICU抢救、中转手术)、治疗过程中并发症发生情况及30 d内预后状况。结果160例患者中保守治疗64例(40.0%),入住ICU抢救96例(60.0%);中转手术34例(21.3%)。MEWS评分>8分者16例,均分诊为入住ICU抢救,保守治疗率明显低于其他各分值段(MEWS评分>6~8分除外),入住ICU抢救率明显高于其他各分值段(MEWS评分>6~8分除外),中转手术率明显低于MEWS评分<3分及3~4分值段,上述差异均有统计学意义(P<0.05)。160例患者30 d内预后良好124例(77.5%),MEWS评分为(2.44±1.32)分;预后不良36例(22.5%),MEWS评分为(6.84±2.12)分,其中死亡12例(7.5%),感染16例(10.0%),多器官衰竭4例(2.5%),应激溃疡4例(2.5%)。ROC曲线分析显示MEWS评分对腹部闭合性创伤患者预后不良有一定预测价值,曲线下面积为0.919(P<0.001,95%CI=0.797~1.000),预测预后不良最佳截断值为5.970分,敏感度0.667,特异度0.986。结论采用MEWS预警评分对评估腹部闭合性创伤患者就诊时分诊及预后具有重要作用,减少并发症及死亡率,改善预后。
Objective To observe the clinical effect of modified early warning score(MEWS) in evaluating closed abdominal trauma. Methods From January 2008 to November 2017,one hundred and sixty patients with closed abdominal trauma admitted to the Fifth People's Hospital of Wuhu were enrolled. Clinical diagnosis and prognosis data were retrospectively analyzed. The MEWS system was used to evaluate the patients' diagnosis(outpatient or specialist conservative treatment, ICU rescue, transfer operation), complications in the course of treatment and 30 days' prognosis. Results Among the 160 patients, 64 cases(40.0%) were treated conservatively, 96(60.0%) were admitted to ICU, and 34(21.3%) underwent transfer operation. There were 16 cases with MEWS score >8. The rate of conservative treatment was significantly lower than that of other scores(except of MEWS score >6-8). The rate of rescue in ICU(100.0%) was significantly higher than that in other segments(except of MEWS score >6-8). The conversion rate was significantly lower than the MEWS score <3 and 3-4 segments. The prognosis in 30 d was good in 124 cases(77.5%), the MEWS score was(2.44±1.32), 36(22.5%) with poor prognosis, and the MEWS score was 6.84±2.12. Twelve cases(7.5%) died, 16(10.0%) were infected, 4(2.5%) had multiple organ failure, and 4 cases(2.5%) suffered from stress ulcer. The ROC curve analysis showed that the MEWS score had a certain predictive value for poor prognosis in patients with closed abdominal trauma. Area under the curve was 0.919(P<0.001, 95% CI=0.797-1.000), the cut-off value was 5.970, the sensitivity was 0.667, and the specificity was 0.986. Conclusion MEWS plays an important role in choosing triage protocols and evaluatingprognosis of closed abdominal trauma, reducing complications and mortality, and improving the prognosis.
Objective To observe the clinical effect of modified early warning score(MEWS) in evaluating closed abdominal trauma. Methods From January 2008 to November 2017,one hundred and sixty patients with closed abdominal trauma admitted to the Fifth People's Hospital of Wuhu were enrolled. Clinical diagnosis and prognosis data were retrospectively analyzed. The MEWS system was used to evaluate the patients' diagnosis(outpatient or specialist conservative treatment, ICU rescue, transfer operation), complications in the course of treatment and 30 days' prognosis. Results Among the 160 patients, 64 cases(40.0%) were treated conservatively, 96(60.0%) were admitted to ICU, and 34(21.3%) underwent transfer operation. There were 16 cases with MEWS score >8. The rate of conservative treatment was significantly lower than that of other scores(except of MEWS score >6-8). The rate of rescue in ICU(100.0%) was significantly higher than that in other segments(except of MEWS score >6-8). The conversion rate was significantly lower than the MEWS score <3 and 3-4 segments. The prognosis in 30 d was good in 124 cases(77.5%), the MEWS score was(2.44±1.32), 36(22.5%) with poor prognosis, and the MEWS score was 6.84±2.12. Twelve cases(7.5%) died, 16(10.0%) were infected, 4(2.5%) had multiple organ failure, and 4 cases(2.5%) suffered from stress ulcer. The ROC curve analysis showed that the MEWS score had a certain predictive value for poor prognosis in patients with closed abdominal trauma. Area under the curve was 0.919(P<0.001, 95% CI=0.797-1.000), the cut-off value was 5.970, the sensitivity was 0.667, and the specificity was 0.986. Conclusion MEWS plays an important role in choosing triage protocols and evaluatingprognosis of closed abdominal trauma, reducing complications and mortality, and improving the prognosis.
引文
[1]陶瑞雨,余稳稳,闫开旭,等.腹部闭合性损伤的研究进展[J].中国现代普通外科进展,2017,20(2):166-168.
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[9]谭云鹤,韦建革,徐育智,等.改良早期预警评分在急诊创伤中的应用研究[J].广西医学,2015,37(9):1352-1353.
[10]冯海丽,廖春燕,陈世娟,等.改良早期预警评分与校正改良早期预警评分在全麻术后患者转运中的应用比较[J].广东医学,2015,36(19):3086-3088.
[11]王莉荔,杜捷夫,陈威,等.改良早期预警评分与国家早期预警评分对老年急诊患者病情评估的比较[J].中国全科医学,2015,18(14):1680-1683.
[12]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.
[13]唐碧波.MEWS评分法对急诊创伤患者的评估效果[J].现代预防医学,2014,41(4):768-769.
[14]顾明,付阳阳,李晨,等.改良早期预警评分在急诊重症患者早期死亡中的预测价值[J].中华危重病急救医学,2015,27(8):687-690.
[15]卫婷婷,王艳梅,侯铭,等.改良早期预警评分用于预测急诊潜在危重病患者预后的探讨[J].中国护理管理,2015,15(2):153-155.
[16]卢生芳,郭玉刚,李长风,等.改良早期预警评分和生理评分系统及危险患者评分对急诊科抢救室患者预后评估的应用价值研究[J].中国全科医学,2016,19(12):1414-1419.
[17]Bilben B,Grandal L,S?vik S.National Early Warning Score(NEWS)as an emergency department predictor of disease severity and 90-day survival in the acutely dyspneic patient-a prospective observational study[J].Scand J Trauma Resusc Emerg Med,2016,24:80.
[18]Dundar ZD,Ergin M,Karamercan MA,et al.Modified Early Warning Score and Vital Pac Early Warning Score in geriatric patients admitted to emergency department[J].Eur J Emerg Med,2016,23(6):406-412.
[2]Iaselli F,Mazzei MA,Firetto C,et al.Bowel and mesenteric injuries from blunt abdominal trauma:a review[J].Radiol Med,2015,120(1):21-32.
[3]Roney JK,Whitley BE,Maples JC,et al.Modified early warning scoring(MEWS):evaluating the evidence for tool inclusion of sepsis screening criteria and impact on mortality and failure to rescue[J].J Clin Nurs,2015,24(23-24):3343-3354.
[4]Kruisselbrink R,Kwizera A,Crowther M,et al.Modified early warning score(MEWS)identifies critical illness among ward patients in a resource restricted setting in Kampala,Uganda:A prospective observational study[J].PLo S One,2016,11(3):e0151408.
[5]吴孟超,吴在德.黄家驷外科学[M].7版.北京:人民卫生出版社,2008:1756-1759.
[6]Lee LL,Yeung KL,Lo WY,et al.Evaluation of a simplified therapeutic intervention scoring system(TISS-28)and the modified early warning score(MEWS)in predicting physiological deterioration during inter-facility transport[J].Resuscitation,2008,76(1):47-51.
[7]Wykes B,Ahmed S,Dubois S,et al.Implementation of the Modified Early Warning Score(MEWS)in a community hospital[J].CHEST,2015,148(4):485.
[8]吴玮玲,黎春常.分级分区管理模式下急诊分诊现状调查及影响因素分析[J].护理学杂志,2016,31(20):69-71.
[9]谭云鹤,韦建革,徐育智,等.改良早期预警评分在急诊创伤中的应用研究[J].广西医学,2015,37(9):1352-1353.
[10]冯海丽,廖春燕,陈世娟,等.改良早期预警评分与校正改良早期预警评分在全麻术后患者转运中的应用比较[J].广东医学,2015,36(19):3086-3088.
[11]王莉荔,杜捷夫,陈威,等.改良早期预警评分与国家早期预警评分对老年急诊患者病情评估的比较[J].中国全科医学,2015,18(14):1680-1683.
[12]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.
[13]唐碧波.MEWS评分法对急诊创伤患者的评估效果[J].现代预防医学,2014,41(4):768-769.
[14]顾明,付阳阳,李晨,等.改良早期预警评分在急诊重症患者早期死亡中的预测价值[J].中华危重病急救医学,2015,27(8):687-690.
[15]卫婷婷,王艳梅,侯铭,等.改良早期预警评分用于预测急诊潜在危重病患者预后的探讨[J].中国护理管理,2015,15(2):153-155.
[16]卢生芳,郭玉刚,李长风,等.改良早期预警评分和生理评分系统及危险患者评分对急诊科抢救室患者预后评估的应用价值研究[J].中国全科医学,2016,19(12):1414-1419.
[17]Bilben B,Grandal L,S?vik S.National Early Warning Score(NEWS)as an emergency department predictor of disease severity and 90-day survival in the acutely dyspneic patient-a prospective observational study[J].Scand J Trauma Resusc Emerg Med,2016,24:80.
[18]Dundar ZD,Ergin M,Karamercan MA,et al.Modified Early Warning Score and Vital Pac Early Warning Score in geriatric patients admitted to emergency department[J].Eur J Emerg Med,2016,23(6):406-412.