转院患者的改良早期预警评分对转运过程影响的临床研究

目的探讨转院患者的改良早期预警评分(MEWS)对患者转运过程的影响。方法对广西医科大学第四附属医院急诊科负责转运的患者,转运前进行改良早期预警评分的评定,并观察不同评分分值的患者是否转运及在转运过程中发生病情恶化和死亡的比率。结果转院前MEWS评分为0~4分组的患者,转运途中发生病情恶化的患者仅占3.82%,经及时处理,100%安全转运至目的地,无死亡病例;5分≤MEWS≤7分组的患者转运途中发生病情恶化的占48.79%,经在救护车上积极抢救,能安全转运至目的地的占91.56%,死于途中或急诊科的占8.44%;MEWS≥8分组的危重症患者留当地有治疗条件的医院继续抢救的占57.31%,当地医院不具备抢救条件而转运的余下的患者100%转运途中发生病情恶化,能安全转运至目的地的占36.28%,需气管插管辅助呼吸者占33.90%,转运途中进行过心肺脑复苏的占29.82%,最终死于途中或急诊科的占25.66%,3组患者病情恶化及死亡比率间相比较,有显著的统计学差异,P<0.01,说明MEWS≤4分时进行院际转运时较安全,≥5分后转运途中发生病情恶化或死亡的风险显著增加。结论 MEWS评分能对患者转运过程中的安全性进行客观、有效的评估和分类,是院际转运时有效、简便、快捷、客观、实用的病情评估方法和模式,值得在实际工资中推广应用。

Clinical study on the Effects of Modified Early warning scores on Transferring Process between the Hospitals

Objectives To discuss the effect of modified early warning scores（MEWS） on transferring process between the hospitals.Methods The patients of emergency department in the Fourth Affiliated Hospital of Guangxi Medical University being transferred to other hospitals were assessed with MEWS and the transference,changes of the patients＇ conditions and mortality were observed.Results For the patients with MEWS of 0-4,the deterioration of the diseases accounted 3.82% and all of them could be transferred successfully after timely treatment without death.The patients with scores between 5 and 7,the deterioration of the diseases accounted 48.79%.After treatment on the ambulance,91.56% of them were transferred safely to another hospital with death rate of 8.44%.As for the patients with MEWS ≥8,57.31% of them were treated at local hospitals and the rest were transferred with 100% deterioration,36.28% of success,33.90% of trachea intubations,29.82% of cardiopulmonary-cerebral resuscitation（CPCR） and 25.66% of death on the way or in emergency room.There was significant difference in deterioration and mortality among the three groups.（P0.01）,indicating that it is safer to transfer the patients with MEWS≤4 and deterioration and mortality increase significantly with MEWS≥5.Conclusion MEWS can evaluate the safety of patients being transferred,which is an easy,effective and applicable method in the process of transference.