MEWS评分和APACHEⅡ评分对急诊老年危重症患者预后的评估

目的研究改良早期预警评分(MEWS)和急性生理与慢性健康状况评估(APACHEⅡ)评分对急诊老年危重症患者预后的评估价值。方法收集首都医科大学宣武医院急诊监护室老年患者158例,入院后分别给予MEWS评分与APACHEⅡ评分,比较死亡组与存活组MEWS评分、APACHEⅡ评分的差别,分别比较MEWS评分与APACHEⅡ评分受试者工作特征曲线(ROC)下面积的区别及MEWS评分≤3分、4～6分,7～9分、≥10分患者病死率的区别,研究MEWS评分与APACHEⅡ评分的相关性。结果死亡组MEWS评分和APACHEⅡ评分分别为(8.06±2.71)分和(24.60±4.20)分,存活组分别为(4.80±2.47)分和(19.06±3.93)分(P<0.01),MEWS评分ROC下面积为0.814,与APACHEⅡ评分比较差异无统计学意义(P>0.05);随着MEWS分值增加,病死率升高(P<0.01);MEWS评分与APACHEⅡ评分具有相关性(r=0.647,P=0.001)。结论 MEWS评分是一种方便、快捷的评分系统,和APACHEⅡ评分一样能够评估急诊老年危重患者的病情和预后。

Evaluation of the Prognosis for Elderly Critical Patients in Emergency Department Using MEWS Score and APACHE Ⅱ Score

Objective To study the assessment value of Modified Early Warning Score(MEWS) and Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ) score for the prognosis of critical elderly patients in emergency department.Methods 158 elderly patients from emergency ICU of Xuanwu Hospital of Capital University of Medical Sciences were collected.MEWS score and APACHE Ⅱ score were calculated for them and the differences were compared between death group and survival group.The difference of the area under receiver operating characteristic curve(AUROCC) were compared between MEWS score and APACHEⅡ score.The death rate were analyzed in the different groups with MEWS score ≤ 3,4-6,7-9,and ≥ 10 respectively.The correlation analysis of MEWS score and APACHE Ⅱscore was done.Results MEWS score and APACHE Ⅱ score in death group were 8.06±2.71 and 24.60±4.20 respectively,those in survival group were 4.80±2.47 and 19.06±3.93 respectively(P<0.01).AUROCC of MEWS score was 0.814,with no significant difference between MEWS score and APACHE Ⅱscore(P>0.05).With MEWS increasing,the fatality rose(P<0.01).MEWS score and APACHE Ⅱ score were correlated(r=0.647,P=0.001).Conclusion MEWS score,as well as APACHE Ⅱ score,is a convenient and fast scoring system,with which the disease condition and prognosis of critical elderly patients can be assessed.