快速急诊内科评分和改良早期预警评分对重症中暑患者预后判断的比较研究
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摘要
目的:比较快速急诊内科评分(REMS)及改良早期预警评分(MEWS)对重症中暑患者预后的预测价值,探讨更适合判断重症中暑患者病情的评分方法。方法:对34例重症中暑患者临床资料进行回顾性分析,分别比较存活及死亡患者入院RMES和MEWS差异,并通过受试者工作特征曲线(ROC曲线)对比两种评分对重症中暑患者预后判断的准确性。结果:存活及死亡患者入院REMS分值分别为5.15±3.21、7.88±3.36,差异有统计学意义(P=0.046);MEWS分值分别为6.12±2.92、9.25±2.05,差异有统计学意义(P=0.008);REMS和MEWS对重症中暑患者预后判断的ROC曲线下面积分别为0.736(95%CI:0.529~0.942)和0.810(95%CI:0.646~0.974),差异无统计学意义。结论:REMS和MEWS均能较好的判断重症中暑患者的预后,其中MEWS评分灵敏度更高,更适用于急诊及院前高危重症中暑患者的早期识别和筛查。
Objective:To compare the application value of rapid emergency medicine score(REMS)and modified early warning score(MEMS)in the prognosis prediction of intensive heat stroke patients.Method:The clinical information of 34 intensive heat stroke patients was retrospectively collected and analyzed.The admission REMS and MEWS score was compared between the intensive heat stroke patients.The receiver operating characteristic curve was used to identify and compare the value of admission REMS and MEWS in predicting the prognosis of intensive heat stroke patients.Result:The REMS score of intensive heat stroke was 5.15±3.21 vs.7.88±3.36 for survived and died patients respectively.The difference was statistically significant with a P-value of 0.046.The MEWS score was 6.12±2.92 vs.9.25±2.05 respectively and the P-value was 0.008.The area under the ROC curve of REMS and MEWS score in predicting the prognosis of intensive heat stroke patients were 0.736(95%CI:0.529~0.942)and 0.810(95%CI:0.646~0.974)respectively,and the P-value was 0.522.Conclusion:The REMS and MEWS scoring scale can precisely predict the prognosis of intensive heat stroke patients.The admission MEWS has a higher sensitivity and is more suitable in guiding the assessment and treatment of intensive heat stroke patients in pre-hospital and emergency department.
Objective:To compare the application value of rapid emergency medicine score(REMS)and modified early warning score(MEMS)in the prognosis prediction of intensive heat stroke patients.Method:The clinical information of 34 intensive heat stroke patients was retrospectively collected and analyzed.The admission REMS and MEWS score was compared between the intensive heat stroke patients.The receiver operating characteristic curve was used to identify and compare the value of admission REMS and MEWS in predicting the prognosis of intensive heat stroke patients.Result:The REMS score of intensive heat stroke was 5.15±3.21 vs.7.88±3.36 for survived and died patients respectively.The difference was statistically significant with a P-value of 0.046.The MEWS score was 6.12±2.92 vs.9.25±2.05 respectively and the P-value was 0.008.The area under the ROC curve of REMS and MEWS score in predicting the prognosis of intensive heat stroke patients were 0.736(95%CI:0.529~0.942)and 0.810(95%CI:0.646~0.974)respectively,and the P-value was 0.522.Conclusion:The REMS and MEWS scoring scale can precisely predict the prognosis of intensive heat stroke patients.The admission MEWS has a higher sensitivity and is more suitable in guiding the assessment and treatment of intensive heat stroke patients in pre-hospital and emergency department.
引文
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[11]李博志,胡怀强,程明,等.3种评分量表对热射病预后评估的比较[J].医学研究生学报,2016,29(5):518-521.
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[13]Knaus W A,Draper E A,Wagner D P,et al.APACHEⅡ:a severity of disease classification system.[J].Crit Care Med,1985,13:818-829.
[14]朱简.APACHEⅡ评分在临床应用的现状及进展[J].医学综述,2011,17(21):3297-3299.
[15]Olsson T.Comparison of the rapid emergency medicine score and apache ii in nonsurgical emergency department patients[J].Acad Emerg Med,2003,10:1040-1048.
[16]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.
[17]李亮,任艺,邵旦兵,等.SIRS评分、REMS评分和APACHEⅡ评分在急诊危重患者预后评估中的对比研究[J].临床急诊杂志,2014,15(5):248-250.
[18]张霞,王霆,蔡琦,等.改良早期预警评分对热射病患者病情评估和死亡预测的价值[J].中国急救医学,2014,34(9):837-839.
[2]Olsson T,Terent A,Lind L.Rapid emergency medicine score:a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients[J].J Intern Med,2004,255:579-587.
[3]Subbe C P,Kruger M,Rutherford P,et al.Validation of a modified early warning score in medical admissions[J].QJM,2001,94:521-526.
[4]任艺,邵旦兵,刘红梅,等.3种评分系统在急诊危重患者预后评估中的对比研究[J].医学研究生学报,2013,26(5):493-496.
[5]Dundar Z D,Karamercan M A,Ergin M,et al.Rapid emergency medicine score and HOTEL score in geriatric patients admitted to the emergency department[J].Int J Gerontol,2015,9:87-92.
[6]Simon H B.Hyperthermia[J].N Engl J Med,1993,329:483-487.
[7]郑世华,朱宗耀,罗和生,等.中暑并发血氨升高23例临床分析[J].临床急诊杂志,2008,9(6):355-356.
[8]Meehl G A,Tebaldi C.More intense,more frequent,and longer lasting heat waves in the 21st century[J].Science,2004,305:994-997.
[9]何玲玲,陈正洪.武汉市居民中暑与气象因子的统计特点研究[J].气候与环境研究,2009,14(5):531-536.
[10]周京江,赵佳佳,周飞虎,等.APACHEⅡ评分对劳力性热射病患者预后判断的价值[J].解放军医学院学报,2013,15(11):1141-1143.
[11]李博志,胡怀强,程明,等.3种评分量表对热射病预后评估的比较[J].医学研究生学报,2016,29(5):518-521.
[12]潘志国,耿焱,刘云松,等.APACHEⅡ评分对重症中暑患者预后判断的价值[J].山东医药,2012,52(9):64-65.
[13]Knaus W A,Draper E A,Wagner D P,et al.APACHEⅡ:a severity of disease classification system.[J].Crit Care Med,1985,13:818-829.
[14]朱简.APACHEⅡ评分在临床应用的现状及进展[J].医学综述,2011,17(21):3297-3299.
[15]Olsson T.Comparison of the rapid emergency medicine score and apache ii in nonsurgical emergency department patients[J].Acad Emerg Med,2003,10:1040-1048.
[16]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.
[17]李亮,任艺,邵旦兵,等.SIRS评分、REMS评分和APACHEⅡ评分在急诊危重患者预后评估中的对比研究[J].临床急诊杂志,2014,15(5):248-250.
[18]张霞,王霆,蔡琦,等.改良早期预警评分对热射病患者病情评估和死亡预测的价值[J].中国急救医学,2014,34(9):837-839.