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。
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.
[1] 安莹,王艳玲. 慢性阻塞性肺疾病急性加重期患者短期预后预测模型的建立[J]. 中华护理杂志,2019,54(1):42-46.
An Y,Wang YL.Establishment of short-term prognostic rules for patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chin J Nurs,2019,54(1):42-46.
[2] 刘青. 加强指南学习规范AECOPD的急诊管理[J]. 中国急救医学,2014,34(12):1072-1075.
Liu Q.Strengthen the study of guidelines and standardize the emergency management of AECOPD[J]. Chin J Crit Care Med,2014,34(12):1072-1075.
[3] 金静芬,陈玉国,朱华栋,等. 急诊预检分诊标准(成人部分)[J]. 中华急危重症护理杂志,2020,1(1):45-48.
Jin JF,Chen YG,Zhu HD,et al.Emergency triage scale(adult part)[J]. Chin J Emerg Crit Care Nurs,2020,1(1):45-48.
[4] Mitsunaga T,Hasegawa I,Uzura M,et al.Comparison of the National Early Warning Score(NEWS) and the Modified Early Warning Score(MEWS) for predicting admission and in-hospital mortality in elderly patients in the pre-hospital setting and in the emergency department[J]. Peer J,2019,7:e6947.
[5] 覃辉. 呼气末二氧化碳监测结合MEWS评分对急诊危重患者预后评估的研究[D]. 湖州:湖州师范学院,2019.
Qin H.The study of end-tidal carbon doxide monitoring with the MEWS to evaluate the prognosis of critical and severe patients in emergency department[D]. Huzhou:Huzhou University,2019.
[6] 急诊呼气末二氧化碳监测专家共识组. 急诊呼气末二氧化碳监测专家共识[J]. 中国急救医学,2017,37(7):585-589.
Expert Consensus Group on Emergency End-expiratory CO2 Mo-nitoring. Expert consensus on emergency end-expiratory CO2 mo-nitoring[J]. Chin J Crit Care Med,2017,37(7):585-589.
[7] 刘娜,李文强,高成伟,等. 呼气末二氧化碳分压测定在慢性阻塞性肺疾病急性加重期中的应用[J]. 疑难病杂志,2017,16(3):239-241,250.
Liu N,Li WQ,Gao CW,et al.Application of end tidal carbon dioxide tension monitoring acute exacerbation of chronic obstructive pulmonary disease patients[J]. Chin J Difficult Complicat Cases,2017,16(3):239-241,250.
[8] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013年修订版)[J]. 中华结核和呼吸杂志,2013,36(4):255-264.
Chronic Obstructive Pulmonary Disease Group of Respiratory Committee of Chinese Medical Association. Guidelines for diagnosis and treatment of chronic obstructive pulmonary disease(Revised 2013)[J]. Chin J Tuberc Respir Dis,2013,36(4):255-264.
[9] Sandroni C,de Santis P,D'Arrigo S. Capnography during cardiac arrest[J]. Resuscitation,2018,132:73-77.
[10] 黄文婷,崔妙玲,蒋云,等. 慢性阻塞性肺疾病急性加重期患者病情评分工具的比较研究[J]. 中华护理杂志,2017,52(3):381-384.
Huang WT,Cui ML,Jiang Y,et al.A prospective validation of NEWS,CREWS and BAP-65 among patients with AECOPD[J]. Chin J Nurs,2017,52(3):381-384.
[11] 吴林,尹文. 慢性阻塞性肺疾病急性加重的诊治进展[J]. 中国急救医学,2019,39(5):486-490.
Wu L,Yin W.Progress in diagnosis and treatment of acute exacerbation of chronic obstructive pulmonary disease[J]. Chin J Crit Care Med,2019,39(5):486-490.
[12] Blankush JM,Freeman R,McIlvaine J,et al. Implementation of a novel postoperative monitoring system using automated Modified Early Warning Scores(MEWS) incorporating end-tidal capnography[J]. J Clin Monit Comput,2017,31(5):1081-1092.
[13] Shetty A,Sparenberg S,Adams K,et al.Arterial to end-tidal carbon dioxide tension difference(CO2 gap) as a prognostic marker for adverse outcomes in emergency department patients presenting with suspected sepsis[J]. Emerg Med Australas,2018,30(6):794-801.
[14] 曾雪萍,孙峰,徐军. 呼气末二氧化碳分压在血流动力学管理中的应用进展[J]. 中国急救医学,2019,39(2):192-195.
Zeng XP,Sun F,Xu J.Application progress of partial pressure of end-tidal carbon dioxide in hemodynamic management[J]. Chin J Crit Care Med,2019,39(2):192-195.
[15] 施毅. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J]. 中华结核和呼吸杂志,2018,41(4):255-280.
Shi Y.Guidelines for the diagnosis and treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in chinese adults(2018 edition)[J]. Chin J Tuberc Respir Dis,2018,41(4):255-280.
[16] 金双燕,祁海鸥,周大春. 呼气末二氧化碳分压监测在麻醉复苏室中的应用[J]. 中华护理杂志,2015,50(4):498-499.
Jin SY,Qi HO.End-tidal carbon dioxide partial pressure monitoring applied in the post anesthesia care unit[J]. Chin J Nurs,2015,50(4):498-499.
[17] Hunter CL,Silvestri S,Ralls G,et al.The sixth vital sign:prehospital end-tidal carbon dioxide predicts in-hospital mortality and metabolic disturbances[J]. Am J Emerg Med,2014,32(2):160-165.
[18] 郑强. PetCO2早期识别ALHF与AECOPD所致呼吸困难的参考价值[D]. 南充:川北医学院,2018.
Zheng Q.Early recognition value of PetCO2 for dyspnea caused by ALHF and AECOPD[D]. Nanchong:North Sichuan Medical College,2018.
[19] Jo T,Inomata M,Takada K,et al.Usefulness of measurement of end-tidal CO2 using a portable capnometer in patients with chronic respiratory failure receiving long-term oxygen therapy[J]. Intern Med,2020,59(14):1711-1720.
[20] 郭轶斌,郭威,秦宇辰,等. 基于Kappa系数的一致性检验及其软件实现[J]. 中国卫生统计,2016,33(1):169-170,174.
Guo YB,Guo W,Qin YC,et al.Consistency test based on Kappa coefficient and its software implementation[J]. Chin J Heal Stat,2016,33(1):169-170,174.
