改良早期预警评分与 ABCD2评分对急性脑卒中患者预后的预测价值研究

摘要

Objective To investigate the predictive value of MEWS and ABCD2 score on prognosis of patients with acute stroke. Methods A total of 249 patients with acute stroke were selected in the Traditional Chinese Medicine Hospital of Handan from June 2013 to December 2014,and their clinical data was collected immediately after admission,including body temperature,heart rate, respiratory rate, systolic blood pressure, conscious state, clinical manifestation, duration of symptoms,history of diabetes and so on,and then MEWS and ABCD2 score were evaluated. ROC curve was drawn to analyze the predictive value of MEWS and ABCD2 on prognosis of patients with acute stroke. Results During the 30 - day follow - up,219 cases survived,30 cases died,the fatality rate was 12. 05% (30 / 249). The AUC of MEWS in predicting the prognosis of patients with acute stroke was 0. 901 〔 95% CI( 0. 854,0. 936 )〕,when it was 4. 5,the sensitivity was 85. 84% ,the specificity was 80. 00% ,the accuracy rate was 85. 14% ;the AUC of ABCD2 score in predicting the prognosis of patients with acute stroke was 0. 832〔95% CI(0. 815,0. 941)〕,when it was 4. 0,the sensitivity was 80. 37% ,the specificity was 73. 33% ,the accuracy rate was 79. 52% ;the AUC of MEWS combined with ABCD2 score in predicting the prognosis of patients with acute stroke was 0. 975 〔 95% CI( 0. 912,0. 987 )〕,when it was 4. 5 and 4. 0,respectively,the sensitivity was 91. 32% ,the specificity was 80. 00% ,the accuracy rate was 89. 96%. The AUC of MEWS in predicting the prognosis of patients with acute stroke was statistically significantly higher than that of ABCD2 score( P ﹤ 0. 05),meanwhile the AUC of MEWS combined with ABCD2 score in predicting the prognosis of patients with acute stroke was statistically significantly higher than that of MEWS and ABCD2 score,respectively(P ﹤ 0. 05). Conclusion MEWS combined with ABCD2 score can exactly evaluate the illness severity of patients with acute stroke,has relatively higher predictive value.%目的：探讨改良早期预警评分（MEWS）与 ABCD2评分对急性脑卒中患者预后的预测价值。方法选取2013年6月—2014年12月邯郸市中医院收治的急性脑卒中患者249例，入院后即刻收集患者体温、心率、呼吸频率、收缩压、意识状态、临床表现、症状持续时间、糖尿病病史等临床资料，分别进行 MEWS、ABCD2评分。绘制受试者工作特征曲线（ROC）以评价 MEWS、ABCD2评分对急性脑卒中患者预后的预测价值。结果随访30 d，存活219例，死亡30例，病死率为12.05%（30/249）。MEWS 预测急性脑卒中患者预后的曲线下面积（ AUC）为0.901〔95% CI（0.854，0.936）〕，当其为4.5分时，灵敏度为85.84%，特异度为80.00%，准确率为85.14%；ABCD2评分预测急性脑卒中患者预后的 AUC 为0.832〔95% CI（0.815，0.941）〕，当其为4.0分时，灵敏度为80.37%，特异度为73.33%，准确率为79.52%；MEWS 联合 ABCD2评分预测急性脑卒中患者预后的 AUC 为0.975〔95% CI （0.912，0.987）〕，当其分别为4.5和4.0分时，灵敏度为91.32%，特异度为80.00%，准确率为89.96%。MEWS 预测急性脑卒中患者预后的 AUC 高于 ABCD2评分（P ﹤0.05），MEWS 联合 ABCD2评分预测急性脑卒中患者预后的 AUC高于 MEWS、ABCD2评分（P ﹤0.05）。结论 MEWS 联合 ABCD2评分能有效评估急性脑卒中患者病情，对患者预后的预测价值较高。