摘要
【目的】探讨急诊危重指数与早期预警评分系统对急性冠脉综合征(acute coronary syndrome,ACS)急救效率的影响,以及3种早期预警评分系统对ACS患者预后的评估价值。【方法】选择急诊科600例ACS患者,按照护理方式不同分为对照组和观察组,各300例。对照组患者给予常规护理分诊急救,观察组患者给予急诊危重度指数(emergency severity index,ESI)分级就诊,比较两组患者的急诊效率。之后以患者入院时第一次生命体征监测值为基础,对国家早期预警评分(national early warning score,NEWS)、标准早期预警评分(standard early warning score,SEWS)以及改良早期预警评分(modified early warning score,MEWS)进行计算,采用Fisher判别原理对ESI与3种评分(经由ESI分级就诊的观察组患者)的相关性进行分析,并采用交叉核实法和回代法进行误判率估算。并以患者28 d死亡为终点,将观察组患者分为生存组和死亡组两组,比较两组患者的3种评分差异,采用受试者工作特征曲线(receiver operator characteristic curve,ROC)分析3种评分对预后的评估价值。【结果】对照组患者t1、t2、t3明显高于观察组(P<0.05)。经交叉验证法和回代法验证显示,NEWS系统的误判率最低,SEWS系统的误判率最高,进一步分析,NEWS系统判别急性心肌梗死(acute myocardial infarction,AMI)患者ESI分级的特异性为92.61%,灵敏度为93.84%,准确性为93.10%,可以较好地对I级和Ⅱ级患者进行判别。经过ROC曲线分析,NEWS、MEWS以及SEWS评分的曲线下面积(area under the curve,AUC)分别为0.878、0.830、0.782,其中NEWS的AUC最大,预后评估价值更高。【结论】应用ESI分诊系统可以提高AMI患者的急诊效率,且NEWS评分系统可以协助医生对患者病情量化、分级以及前瞻性研究,对预后也具有较好的预测效能,具有较好的临床应用价值。
【Objective】 To investigate the effect of emergency critical index and early warning scoring system on the emergency response rate of acute coronary syndrome(ACS) and the value of three early warning scoring systems in evaluating the prognosis of patients with ACS.【Methods】A retrospective analysis of 600 patients with ACS admitted to our hospital was carried out and the patients were randomly divided into control group and observation group according to the nursing mode, 300 cases each. Patients in the control group were given routine care for first aid, and patients in the observation group were given an emergency severity index(ESI)grading. The emergency efficiency between the two groups was compared. The national early warning score(NEWS), standard early warning score(SEWS) and modified early warning score(MEWS) were then calculated based on the first vital signs monitored at the time of admission. The correlation between ESI and three scores(patients in the observation group via ESI grading) was analyzed by Fisher discriminant principle, and the false positive rate was estimated by cross-validation and back-generation. The patient’s 28-day death was the end point, and patients in the observation group were divided into two groups: the survival group and the death group. The difference in the three scores between the two groups was compared,and the receiver operating characteristic curve(ROC) was used to analyze the evaluation of the prognosis of the three scores.【Results】The t1, t2 and t3 in the control group were significantly higher than those in the observation group, and the difference was statistically significant(P<0.05). The results of the cross-validation method and back-test method showed that the NEWS system had the lowest false positive rate and the SEWS system had the highest false positive rate. Further analysis indicated that the NEWS system which distinguished AMI patients with ESI classification specificity of 92.61%, sensitivity of 93.84%, accuracy of 93.10%, could better disting
作者
袁芳
陈玲
YUAN Fang;CHEN Ling(The Third Ward of Central South Hospital of Wuhan University,Wuhan 430071,China)
出处
《武警后勤学院学报（医学版）》
CAS
2019年第9期24-28,共5页
Journal of Logistics University of PAP（Medical Sciences）
基金
湖北省卫生计生委面上项目(WJ2017M037)。
关键词
急诊危重度指数
早期预警评分系统
急性冠脉综合征
急救效率
预后
Emergency criticality index
Early warning scoring system
Acute coronary syndrome
First aid efficiency
Prognosis
