MEWS评分改良及用于血液系统恶性肿瘤感染患者的评价
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潍坊市科技发展计划项目(201302106)


Modification of MEWS score and its application in patients with hematological malignancies and developing infetions
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    目的 探讨影响血液系统恶性肿瘤化疗后粒细胞缺乏期并发感染患者预后的危险因素,以期形成适合血液系统恶性肿瘤感 染预警的校正 MEWS评分表,实现更好的预警效果。方法 回顾性收集符合纳入标准的179例患者资料,釆用多因素 Logistic回 归方法分析影响患者预后的独立危险因素,形成校正 MEWS评分表,依据患者预后及是否实施应急处置,比较分析两种 MEWS 评分的预测效能,评估其分辨度及最佳截断点。结果 多器官功能障碍综合征(MODS)、电解质紊乱、呼吸频率、血氧饱和度及意 识变化是影响患者预后的独立危险因素(均P<0.01);两种评分在死亡组、应急处置组中的分值均分别高于存活组、非应急处置 组(均P<0.01);两种评分在预后的分辨度评价上具有中等程度预测价值,且校正 MEWS评分(AUROC=0.898)的预测价值明 显高于 MEWS评分(AUROC=0.810),最佳截断点分别为8.5、4.5分;在预测实施应急处置上,校正 MEWS评分具有中等程度 预测价值(AUROC=0.730),最佳截断点为5.5分,而 MEWS评分的预测价值较低(AUROC=0.692),最佳截断点为4.5分。结 论 校正 MEWS评分在患者预后及应急处置中呈现中等程度预测价值,更适合血液系统恶性肿瘤化疗后粒细胞缺乏期并发感染 患者的病情评估及预警。

    Abstract:

    Objective To investigate the risk factors of hematologic malignancies patients developing infection in granulocyte deficiency period of chemotherapy, to form a corrected MEWS score suitable for early warning of indection in hematological malignancies patients, and to achieve better early warning results. Methods A retrospective study was conducted to collect data of 179 patients who met the inclusion criteria.Multivariate logistic regression analysis was used to identify the independent risk factors which affected the prognosis of patients, and a corrected MEWS score was formed.According to the patient′s prognosis and whether to implement emergency treatment, the predictive efficacy of the two MEWS scores was compared, and the discrimination and the best cut-off points were evaluated. Results Multiple organ dysfunction syndrome (MODS), electrolyte imbalance, and changes in respi-ratory rate, SaPO2, and consciousness were independent risk factors for prognosis. The scores of the two instruments in the death group and the emergency treatment group were higher than those in the survival group and non-emergency treatment group (P<0.01 for both). The two instruments had moderate predictive value in the prognostic discrimination, and the predicted value of the corrected MEWS score (AUROC=0.898) was significantly higher than the MEWS score (AUROC=0.810), the best cutoff points being 8.5 and 4.5 respectively. In predicting the implementation of emergency response, the corrected MEWS score had medium predictive value (AUROC=0.730), and the optimal cut-off point was 5.5 points, versus lower predictive value(AUROC=0.692) and 4.5 points by MEWS score. Conclusion The corrected MEWS score had a moderate predictive value in prognostic discrimination and emergency implementation, which would be more suitable for the evaluation of hematologic malignancies patients developing infection in granulocyte deficiency period.

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董玉娇,王爱红,王占聚,牟灵英,肖华,张洪玲. MEWS评分改良及用于血液系统恶性肿瘤感染患者的评价[J].护理学杂志,2019,34(7):22-25+41

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  • 收稿日期:2018-11-09
  • 最后修改日期:2019-01-08
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  • 在线发布日期: 2022-08-09