作　　者： (魏捷）; (杜贤进）; (晏晨）; (田丹）; (杨卫泽）; (吕菁君）;

机构地区： 武汉大学人民医院急诊科,武汉430060

出　　处： 《中华急诊医学杂志》 2017年第8期914-918,共5页

摘　　要： 目的探讨改良早期预警评分（MEWS）在中暑患者病情评估及预后预测中的价值。方法收集中暑患者46例，根据病情分为轻症中暑组和重症中暑组；根据治疗结局，分为存活组和死亡组。比较各组患者初始MEWS的差异，并采用受试者工作特征曲线（ROC曲线）评价MEWS判断中暑患者病情和预后的准确性。结果轻症中暑组与重症中暑组患者初始MEWS分值分别为（3．00±1．70）分及（6．85±3．03）分，差异有统计学意义（P=0．004）；初始MEWS对重症中暑判断ROC曲线下面积（AUC）为（0．864±0．056）。好转组及死亡组患者初始MEWS分值分别为（5．13±2．96）分及（9．25±2．05）分，差异有统计学意义（P=0．037）；初始MEWS对中暑患者死亡预测AUC为（0．867±0．061）。结论初始MEWS能对中暑患者病情及预后做出准确判断，初始MEWS大于4．5分可作为重症中暑的判断标准，初始MEWS大于7．5分可作为中暑患者预后不良的预警指标。 Objective To explore the value of modified early warning score （MEWS） in clinical status assessment and outcome prediction of heat stroke patients. Methods The clinical data of 46 heat stroke patients were collected. According to the severity, the subjects were divided into mild group and severe group; and alternatively, according to the treatment outcomes, the subjects were also divided into survival group and death group. The MEWS at admission was employed for comparison of the differences in severity and outcome of heat stroke between groups. Receiver operating characteristic curve （ ROC curve） was used to evaluate the accuracy of MEWS used at admission in assessing severity and predicting outcome of heat stroke patients. Results The results of MEWS calculated at admission in mild and severe heat stroke patients showed significant difference between them （3.00 ± 1.70 vs. 6. 85 ±3.03, P = 0. 004）. The area under the ROC curve （AUC） of MEWS got at admission for the diagnosis of severe heat stroke was 0. 864 ± 0. 056. The results of MEWS obtained at admission in survived and died heat stroke patients were 5.13 ±2. 96 and 9. 25 ± 2. 05, respectively （P = 0. 037）. The AUC of MEWS used at admission for predicting the death of heat stroke patients was 0. 867 ± 0. 061. Conclusions The initial MEWS is useful to accurately assess and predict the outcome of heat stroke patients. Heat stroke patients with higher level of MEWS used at admission than 4. 5 could be diagnosed as severe heat stroke, and whereas the value of MEWS got at admission higher than 7.5 could be the indicator of the poor prognosis.

关 键 词： 改良早期预警评分 中暑 病情评估 诊断 死亡 预后 受试者工作 特征曲线 曲线 可行性