慢性阻塞性肺疾病患者病情危重发生风险评估方法的研究

doi:10.3761/j.issn.2096-7446.2022.01.001

摘要/Abstract

摘要： 目的探讨改良早期预警评分（Modified Early Warning Score,MEWS）联合呼气末二氧化碳分压（partial pressure of end-tidal carbon dioxide,PetCO₂）预测慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary diseases,AECOPD）患者病情危重发生风险的临床效果。方法采用便利抽样法,选取2019年4月—2021年2月进入浙江省某三级甲等医院急诊抢救室就诊的AECOPD患者为研究对象,采用MEWS评分、PetCO₂值进行评估,利用Bayes判别并分析两者评估急诊AECOPD患者病情危重发生风险的准确性,通过受试者工作特征（receiver operator characteristic,ROC）曲线比较两者联合评估对急诊AECOPD患者病情危重发生风险的预测价值。结果共纳入151例AECOPD患者,其中病情危重组66例（43.7%）,病情平稳组85例（56.3%）。病情危重组的MEWS评分、PetCO₂值分别为[7.0（7.0,9.0）]分、[49.5（39.8,68.5）] mmHg（1 mmHg=0.133 kPa）,高于病情平稳组的MEWS评分[6.0（4.0,8.0）]分、PetCO₂值[40.0（36.0,48.0）] mmHg,差异具有统计学意义（P<0.05）。MEWS评分联合PetCO₂值得到的联合预测概率（PRE_1）ROC曲线下面积为0.795[95%CI（0.722,0.856）],灵敏度为0.621,特异度为0.835。分别将MEWS评分、PetCO₂值与PRE_1的ROC曲线下面积进行比较,差异均具有统计学意义（P<0.05）。结论 MEWS评分及PetCO₂值均可以作为评估急诊AECOPD患者病情危重发生风险的指标,两者联合应用有助于急诊医护人员更加科学地分辨病情危重患者。

关键词: 慢性阻塞性肺疾病, 改良早期预警评分, 呼气末二氧化碳分压, 预测模型, 护理

Abstract: Objective To investigate the clinical effect of modified early warning score（MEWS） combined with end-expiratory carbon dioxide（PetCO₂） in predicting the risk of critical condition in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods Convenient sampling method was used to select AECOPD patients admitted to the emergency room of a class A hospital in Zhejiang Province from April 2019 to February 2021 as the study subjects. MEWS score and PetCO₂ value were used to evaluate. Bayes discriminant analysis was used to evaluate the accuracy of the risk of critical condition in emergency AECOPD patients,and the prediction value of the two combined assessments on the risk of critical condition in emergency AECOPD patients was compared by receiver operator characteristic（ROC） curve. Results A total of 151 AECOPD patients were enrolled,including 66 cases（43.7%） in the critical group and 85 cases（56.3%） in the stable group. MEWS score and PetCO₂ value in critical group were [7.0（7.0,9.0）] and [49.5（39.8,68.5）] mmHg,respectively,which was higher than the MEWS score [6.0（4.0,8.0）] and PetCO₂ value [40.0（36.0,48.0）] mmHg in the stable group,and the differences were statistically significant（P<0.05）. The predictive probability（PRE_1） of MEWS score combined with PetCO₂ value was 0.795[95%CI（0.722,0.856）],the sensitivity was 0.621,and the specificity was 0.835. The area under ROC curve of MEWS score,PetCO₂ value and PRE_1 were compared,and the differences were statistically significant（P<0.05）. Conclusion Both MEWS score and PetCO₂ value can be used as effective indicators to evaluate the risk of critical condition in emergency AECOPD patients,and their combined application can help emergency medical staff distinguish critically ill patients more scientifically.

Key words: Chronic Obstructive Pulmonary Disease, Modified Early Warning Score, End-tidal Carbon Dioxide, Forecasting Model, Nursing Care

李彩娟, 金培英, 周庆, 蕈辉, 项芹. 慢性阻塞性肺疾病患者病情危重发生风险评估方法的研究[J]. 中华急危重症护理杂志, 2022, 3(1): 10-15.

LI Caijuan, JIN Peiying, ZHOU Qing, XUN Hui, XIANG Qin. A study on the risk assessment method of critical condition in patients with chronic obstructive pulmonary disease[J]. Chinese Journal of Emergency and Critical Care Nursing, 2022, 3(1): 10-15.

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