三种不同评分在急诊危重患者预后评估中对比探究.doc

三种不同评分在急诊危重患者预后评估中对比探究 【摘要】目的探讨简单临床评分(simple clinical scoRe, SCS)、快速急诊内科评分(Rapid emeRgency medicin scoRe, REMS)和APACHE II评分在评估急诊危重 患者预后的作用效果，并进行对比研究。方法对急诊科412 例患者进行SCS评分、REMS评分和APACHE II评分，追踪患 者去向和预后，并根据其当次入院后病死率，比较三种评分 与急诊危重患者预后的相关性，同时通过R0C曲线下面积大 小，比较三种评分系统预测预后的准确度。结果SCS评分、 REMS评分和APACHE II评分分值越高，死亡危险率越高，各 分组间病死率比较差异均有统计学意义(PO, 05)o结论三 种评分系统均能预测患者的预后，其预测准确度为APACHE II 高于SCS高于REMS；从成本效益方面考虑，SCS评分更适用 于急诊患者的早期预后评估。 【关键词】简单临床评分；快速急诊内科评分；APACHE II评分；急诊科；ROC曲线 Study of diffeRent scoRe systems on pRedicting outcomes in seveRe patients of emeRgency depaRtments Ren Yi, Shao Danbing, Liu Hongmei, Zhang Wei, Xu Baohua, Tang Wenjie, Yang Zhizhou, Sun Baodi, Chen Jiao , Nie Shinan. EmeRgency DepaRtment, Nanjing GeneRal Hospital of Nanjing MilitaRy Command, Nanjing 210002, China CoRResponding authoR : Nie Shinan , Email : shn_nie@sina, com 【AbstRact 】 Objective To evaluate the simple clinical scoRe (SCS), Rapid emeRgency medicin scoRe (REMS) and APACHEII scoRe in pRedicting pRognosis of seveRe patients in emeRgency depaRtment.Methods Data of 412 patients weRe collected at and afteR admission. SCS scoRe , REMS scoRe and APACHE II scoRe weRe calculated in 24 houRs afteR admission. The moRtality of patients with diffeRent scoRe system was analyzed in oRdeR to evaluate the sensitivity and specificity of the thRee scoRe system confiRmed by aRea undeR the ROC cuRve? Results With scoRes incRease, moRtality Rate incReased as a ResuIt of seveRity of illness. TheRe weRe diffeRences in moRtality Rate among the thRee scoRe system (P0, 05)? Conclusions The thRee diffeRent scoRe systems weRe useful in pRedicting outcomes of seveRe patients, and SCS is moRe Reliable in emeRgency depaRtment. [Key woRdslSimple clinical scoRe； Rapid emeRgency medicin scoRe； APACHEII scoRe； EmeRgency depaRtment； ROC cuRve 急诊科患者病情复杂多变，随时可能出现危重病情的恶 化甚至死亡，因此，在早期识别意外发生的“危险信 号” [1],对危重患者进行早期干预，从而阻止病情的恶化, 是急诊科医务工作者的一项重要任务[2]。目前临床上常用 的评分系统有急性生理和慢性健康状况评分(APACHE II/APACHE III).简化急性生理学评分II (SAPS II)和多器 官功能衰竭综合征评分(MODS)等，这些