NEWS MEWS和MEDS对急诊感染患者预后的评估价值比较

doi:10.3969/j.issn.1002-1949.2018.06.001

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摘要目的探讨英国国家早期预警评分（national early warning score, NEWS）、改良早期预警评分（modified early warning score，MEWS）和急诊脓毒症死亡风险评分（mortality in emergency department sepsis score，MEDS）对急诊感染患者预后的评估价值，并探究新的评分方法。方法回顾性分析2016-01～2016-08就诊于清华大学附属北京清华长庚医院急诊科的215例感染患者，记录性别、年龄、既往基础疾病、就诊时生命体征、感染部位及相关实验室检验，分别进行NEWS、MEWS和MEDS，以进入研究后28 d生存情况分为死亡组与存活组，分析两组间各评分差异。为探究新的评分方法，进一步应用Logistic回归分析评估各因素与28 d预后的关系，并最终获得拟合方程。应用受试者工作特征曲线（ROC曲线）比较各评分系统及拟合方程对28 d预后的预测能力。结果 215例急性感染患者28 d 病死率为14.88%。死亡组NEWS、MEWS和MEDS均高于存活组。单因素Logistic回归分析显示，年龄、恶性肿瘤病史、心率、呼吸频率、收缩压、血氧饱和度(SpO2)、血小板、红细胞压积、血肌酐(serum creatinine, Scr)、肾小球滤过率（estimated glomerular filtration rate, eGFR）是28 d死亡的预测因素（P＜0.05）。NEWS、MEWS、MEDS和联合多变量建立的拟合方程对28 d死亡预测的ROC曲线下面积分别为0.881、0.757、0.935和0.954。NEWS与MEDS比较差异无统计学意义（P＞0.05），与MEWS比较差异有统计学意义（P＜0.01）。联合多变量后建立的拟合方程敏感度最佳，曲线下面积最大，优于MEWS（P＜0.01）及NEWS（P＜0.05）。结论 MEDS的预测能力同NEWS能力相当，优于MEWS。联合MEDS与心率、Scr获得的拟合方程的预测能力更优于NEWS和MEWS。

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	宋琳琳
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	龚晓杰
	陈心培
	赵心亮
	陈旭岩

关键词 ：感染, 国家早期预警评分（NEWS）, 改良早期预警评分（MEWS）, 急诊脓毒症死亡风险评分（MEDS）, 预后

通讯作者: 陈旭岩（1964-），女，博士，主任医师，副教授，硕士生导师，E-mail：18601307289@163.com。

作者简介: 宋琳琳（1985-），女，博士，主治医师。

引用本文:

宋琳琳，王琰，张向阳，冯莉莉，王逸群，龚晓杰，陈心培，赵心亮，陈旭岩. NEWS MEWS和MEDS对急诊感染患者预后的评估价值比较[J]. 中国急救医学, 2018, 38(6): 465-.
Song Lin-lin, Wang Yan, Zhang Xiang-yang, Feng Li-li, Wang Yi-qun, Gong Xiao-jie, Chen Xin-pei, Zhao Xin-liang, Chen Xu-yan. Comparison of NEWS, MEWS and MEDS scores for predicting mortality in emergency department patients with infection. Chinese Journal of Critical Care Medicine, 2018, 38(6): 465-.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.06.001 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I6/465

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