中医危重症评分的临床应用评价

摘要

Objective To investigate the clinical application value of traditional Chinese medicine (TCM) critical illness scoring system.Methods 315 critical patients (3 cases were excluded) were evaluated by the TCM critical illness scores and the British National Early Warning Score (NEWS).The death situation at the 10th, 20th and 30th days as the assessment endpoints.The best assessing time of TCM critical illness scoring system for critical disease forecasting were evaluated.The consistency of critical disease between two evaluation system were compared.Results The mortality within 20 and 30 days was obviously increased during 5 to 7 points of TCM critical illness scoring system, there were statistical differences as compared with 2 to 4 points (P<0.05).The mortality reached up to 89.19% (66/74) when the points over 7.The mortality within 20 days began to increase, up to 11.51% (16/139) during the 5 to 7 points of NEWS.The mortality reached up to 89.04% (65/73) when the NEWS over 7.The comparison of curve fitting between two system, Z=0.239,P=0.81, showed that the TCM critical illness scoring system had commendable assessment efficacy.The total mortality began to increase when the points of TCM critical illness scoring system over 5 (P<0.05), the sensitivity was 97.01%, the specificity was 76.2%, and the area under the curve was 0.943, which was the inflection point of critical disease.Conclusion TCM critical illness scores can be used as a clinical evaluation indicator, and the score more than 5 is the demarcation point to distinguish critical condition and predict the prognosis.%目的 探讨中医危重症评分系统的临床应用价值.方法 选取315例重症患者(后剔除3例),采用中医危重症评分进行评估,同时采用英国国家早期预警评分(NEWS)进行评估.以10、20、30 d的死亡情况作为评价终点,评估中医危重症评分系统对危重症预测的最佳评分点,同时比较2种评价系统对危重症预测的一致性.结果 中医危重症5~7分者,20、30 d内死亡率显著增高,与2~4分组比较差异有统计学意义(P<0.05);>7分者,总死亡率达89.19%(66/74).NEWS评分5~7分者,20 d内死亡率开始有所增高,达11.51%(16/139);>7分者,总死亡率达89.04%(65/73).2种评分系统的曲线拟合度比较Z=0.239,P=0.81,提示中医危重症评分亦具有很好的评价效能.中医危重症评分>5分者总死亡率开始增高(P<0.05),此时敏感度达97.01%,特异度为76.2%,曲线下面积为0.943,是预测危重症的拐点.结论 中医危重症评分对危重症预后有很好的评价作用,>5分是区分病情危重和预测预后的分界点.