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

Abstract

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

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.

References

[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.

A study on the risk assessment method of critical condition in patients with chronic obstructive pulmonary disease

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	XU Wei, ZHU Yamei, LIU Kang, WANG Mi, XU Xianrong, MAO Huijuan. Construction and validation of a risk prediction model for autologous arteriovenous fistula occlusion in hemodialysis patients [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(7): 788-795.
[2]	CHEN Guanjie, SUN Jianhua, ZHANG Chi, ZHU Yufen, WU Jiaqun, LI Xiaoqing. A Study on the effect of analgesia-nutrition balanced management on enteral feeding intolerance in patients undergoing prone position ventilation [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(7): 803-811.
[3]	CHEN Jie, RUAN Xiaofen, FANG Lili. Analysis of the current situation and influencing factors of early postoperative pain in patients undergoing thoracoscopic radical resection of lung cancer [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(7): 812-819.
[4]	WANG Shifang, FENG Ping, BAI Jian, LI Xihan, ZHANG Hao. A phenomenological study on the real experience of patients with implanted left ventricular assist device during their first ambulation out of bed [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(6): 667-671.
[5]	ZHAO Wanchen, ZHANG Hui, FANG Yifan, MA Cong, GUO Na. A scoping review of risk prediction models for cognitive impairment after ischemic stroke [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(6): 755-763.
[6]	YING Jinping, CHEN Linglin, CAI Genlian, ZHANG Yujiao, ZHANG Liuqian, ZHANG Jing, ZHOU Jinjin, YING Yayong. Construction and application of a multicomponent exercise training program for pre-frail patients undergoing maintenance hemodialysis [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(5): 517-523.
[7]	HUANG Shaojuan, LI Shufang, CHEN Wenyuan, CHEN Xing, LIANG Yangui, MA Xiaojun, HUANG Qinghua, WU Xiaokun, ZHANG Gai, CHEN Ping. Clinical characteristics observation and nursing care of 67 patients with Chikungunya hemorrhagic fever [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(5): 574-580.
[8]	ZHANG Tianyu, CHENG Lingling, CHENG Zhen, SHAO Weiying, SHI Aili. The effect of early mobilization in adult patients with extracorporeal membrane oxygenation：a meta-analysis [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(5): 616-622.
[9]	LI Chuansheng, MI Yuanyuan, CHEN Lihua, HUANG Weijian. Construction and applicability analysis of emergency response capability evaluation index system for extracorporeal membrane pulmonary oxygenation nurses [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(4): 425-431.
[10]	ZHANG Ping, WENG Fengxia, SANG Ming, WEI Jianhua. A qualitative study of ICU nurses’ psychological experience in coping with injurious behavior of cardiac and macrovascular patients with postoperative delirium [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(4): 481-487.
[11]	ZHANG Shuai, GAO Xin, QIAN Jiawei, WANG Xiao, SHEN Danping, LI Wenya, SHEN Xiulan. Construction and feasibility analysis of a full-process management program for oxygenators in patients undergoing extracorporeal membrane oxygenation therapy [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(3): 266-273.
[12]	LI Jingyi, LIU Yousheng, LIANG Guanmian, YAO Yingyan. Virtual reality for motor rehabilitation in critically ill patients：a scoping review [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(3): 299-305.
[13]	XIA Lianzi, YU Fei, FENG Bo, ZHOU Hui, JI Kangling, WANG Qing. A qualitative study on barriers to participation in advance care planning among ICU surrogate decision-makers [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(2): 155-161.
[14]	HUANG Fangfang, HU Jun, ZHOU Yan, FAN Tianjing, YU Hongji, GAO Bingbing, JIANG Yunlong. A qualitative study on the non-verbal communication needs of mechanically ventilated patients in the ICU [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(2): 168-174.
[15]	ZHANG Lili, ZHANG Yan, WANG Fangfang, HUANG Lihua, YIN Huifang. Patient-reported outcome measures for patients with post-thrombotic syndrome：a systematic review [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(2): 223-230.