妇科患者危重病情变化早期预警评估表的构建及验证

doi:10.3761/j.issn.0254-1769.2021.01.003

摘要/Abstract

摘要：

目的构建妇科患者危重病情变化早期预警评估表,并对预测效果进行验证。方法采用回顾性病例分析,收集南京市某三级甲等医院2018年1月1日—2019年7月31日389例妇科患者资料,确定影响妇科患者危重病情变化的因素,构建妇科患者危重病情变化早期预警评估表,并检验预测效果。结果妇科患者危重病情变化早期预警评估表纳入疾病类型、呼吸频率、心率、收缩压、血氧饱和度、是否吸氧、意识、体温、下腹痛、血红蛋白浓度、阴道流血量、相关症状共12项预警指标,其中是否吸氧、体温、下腹痛、阴道流血量赋值0~2分,其余指标赋值0~3分,12项指标评分相加为总分,总分为0~32分;ROC曲线的最佳截断值为3.5分,灵敏度为92.32%,特异度为88.85%。结论妇科患者危重病情变化早期预警评估表能有效预测妇科患者危重病情变化的风险,有助于提高妇科危重症患者救治的成功率。

关键词: 预警评估表, 危险因素, 风险评估, 妇科学, 护理

Abstract:

Objective To construct the gynecological early warning score（GEWS） of critical patients and to test its predicted performance. Methods Using retrospective case analysis,we collected 389 cases of critical illness changes in gynecological patients from January 1,2018 to July 31,2019 in a level A tertiary hospital in Nanjing. The data was analyzed by single factor and multi-factor analysis to determine the relevant factors of gynecological critical illness changes and construct the GEWS table of critical illness to test the predictive effect of the scale. Results GEWS included 12 early warning indicators,including disease type,respiration rate,heart rate,systolic blood pressure,blood oxygen saturation,oxygen inhalation,consciousness,body temperature,lower abdominal pain,hemoglobin content,vaginal bleeding and related symptoms. Oxygen,body temperature,lower abdominal pain and vaginal bleeding are valued of 0 to 2 points,while other indicators were 0 to 3 points,with a total score of 0 to 32 points for 12 indicators;the best cutoff point of ROC curve was 3.5 points,with a sensitivity of 92.32% and a specificity of 88.85%. Conclusion The GEWS table can effectively warn the changes of critical gynecological conditions and predict the risks of changes in critical gynecological conditions,and help to improve the success rate of gynecological critical patients.

Key words: Warning Assessment Scale, Risk Factors, Risk Assessment, Gynecology, Nursing Care

乔成平,曾丽华,赵蕾,方一宇,乔敏敏,叶敏,张慧雯,刘娅玲,汤聪,屈敏,许华华. 妇科患者危重病情变化早期预警评估表的构建及验证[J]. 中华护理杂志, 2021, 56(1): 21-27.

QIAO Chengping,ZENG Lihua,ZHAO Lei,FANG Yiyu,QIAO Minmin,YE Min,ZHANG Huiwen,LIU Yaling,TANG Cong,QU Min,XU Huahua. Formulation of early warning assessment scale system for the critical illness changes on gynecologic patients and the test of its predictive effectiveness[J]. Chinese Journal of Nursing, 2021, 56(1): 21-27.

图/表 4

表1 妇科患者危重病情变化的单因素分析[例(百分比,%)]

Tab.1 Univariate analysis of changes in critical ilness in gynecological patients[ cases( percentage,%)]

表2 妇科患者危重病情变化的多因素分析

Multivariate analysis of critical illness changes in gynecological patients

表3 妇科危重症早期预警评估量表

Early Warning Assessment Scale for critical gynecological diseases

图1 妇科患者危重病情变化早期预警评估表与国家改良早期预警量表的ROC曲线

Fig 1 The ROC curve of the early warning assessment form for critical illness changes in gynecological patients and the modified version of the national modified early warning scale

参考文献 28

[1]	王炜. 43例妇科急腹症急诊腹腔镜手术疗效观察[J]. 河南外科学杂志, 2019,25(2):126-127.
	Wang W. Observation of the curative effect of emergency laparoscopic surgery in 43 cases of gynecological acute abdomen[J]. Henan J Surg, 2019,25(2):126-127.
[2]	Senthilkumaran S, Jena NN, Jayaraman S, et al. Post coital hemoperitoneum:the pain of love[J]. Turkish J Emerg Med, 2018,18(2):80-81. DOI URL
[3]	van Galen LS, Dijkstra CC, Ludikhuize J, et al. A protocolised once a day modified early warning score(MEWS)measurement is an appropriate screening tool for major adverse events in a general hospital population[J]. PLoS One, 2016,11(8):e0160811. DOI URL
[4]	Abbott TEF, Vaid N, Ip D, et al. A single-centre observational cohort study of admission National Early Warning Score(NEWS)[J]. Resuscitation, 2015,92:89-93. DOI URL PMID
[5]	郭芝廷, 金静芬. 急诊危重度指数与早期预警评分系统的判别模型研究[J]. 中华护理杂志, 2016,51(5):594-598.
	Guo ZT, Jin JF. Discriminatory model of emergency severity index and early warning system[J]. Chin J Nurs, 2016,51(5):594-598.
[6]	唐慧, 杨艳, 李映兰, 等. 儿童早期预警评分在急性淋巴细胞白血病患儿中的应用[J]. 中华护理杂志, 2017,52(12):1422-1426.
	Tang H, Yang Y, Li YL, et al. The warning function of PEWS on septic shock of children with acute lymphoblastic leukemia after chemotherapy[J]. Chin J Nurs, 2017,52(12):1422-1426.
[7]	黄文婷, 崔妙玲, 蒋云, 等. 英国国家早期预警评分及其临床应用研究进展[J]. 护理学杂志, 2016,31(6):101-104.
	Huang WT, Cui ML, Jiang Y, et al. A literature review of the National Early Warning Score and its clinical application[J]. J Nurs Sci, 2016,31(6):101-104.
[8]	《中国高血压基层管理指南》修订委员会. 中国高血压基层管理指南(2014年修订版)[J]. 中华高血压杂志, 2015,23(1):24-43,15.
	Chinese Hypertension Primary Management Guidelines Revision Committee. Chinese Hypertension Primary Management Guidelines(2014 Revised Edition)[J]. Chin J Hypertens, 2015,23(1):24-43,15.
	Chinese Hypertension Primary Management Guidelines Revision Committee. Chinese Hypertension Primary Management Guidelines(2014 Revised Edition)[J]. Chin J Hypertens, 2015,23(1):24-43,15.
[9]	O’Driscoll BR, Howard LS, Davison AG, et al. BTS guideline for emergency oxygen use in adult patients[J]. Thorax, 2008,63(S6):vi1-vi68.
	O’Driscoll BR, Howard LS, Davison AG, et al. BTS guideline for emergency oxygen use in adult patients[J]. Thorax, 2008,63(S6):vi1-vi68.
[10]	Royal College of Physicians. National Early Warning Score(NEWS):standardising the assessment of acute-illness severity in the NHS:report of a working part[R]. London:Royal College of Physicians, 2012: 1.
	Royal College of Physicians. National Early Warning Score(NEWS):standardising the assessment of acute-illness severity in the NHS:report of a working part[R]. London:Royal College of Physicians, 2012: 1.
[11]	Spångfors M, Arvidsson L, Karlsson V, et al. The National Early Warning Score:translation,testing and prediction in a Swedish setting[J]. Intensive Crit Care Nurs, 2016,37:62-67. DOI URL PMID
	Spångfors M, Arvidsson L, Karlsson V, et al. The National Early Warning Score:translation,testing and prediction in a Swedish setting[J]. Intensive Crit Care Nurs, 2016,37:62-67. DOI URL PMID
[12]	Subbe CP. Validation of a modified Early Warning Score in medical admissions[J]. QJM, 2001,94(10):521-526. DOI URL PMID
	Subbe CP. Validation of a modified Early Warning Score in medical admissions[J]. QJM, 2001,94(10):521-526. DOI URL PMID
[13]	王玲. 乳腺癌患者术后淋巴水肿风险评分系统的构建和评价[D]. 合肥:安徽医科大学, 2013.
	王玲. 乳腺癌患者术后淋巴水肿风险评分系统的构建和评价[D]. 合肥:安徽医科大学, 2013.
	Wang L. The establishment and evaluation of scoring system for predicting the risk of breast cancer-related lymphedema[D]. Hefei:Anhui Medical University, 2013.
	Wang L. The establishment and evaluation of scoring system for predicting the risk of breast cancer-related lymphedema[D]. Hefei:Anhui Medical University, 2013.
[14]	Considine J, Street M, Hutchinson AM, et al. Vital sign abnormalities as predictors of clinical deterioration in subacute care patients:a prospective case-time-control study[J]. Int J Nurs Stud, 2020,108:103612. DOI URL PMID
	Considine J, Street M, Hutchinson AM, et al. Vital sign abnormalities as predictors of clinical deterioration in subacute care patients:a prospective case-time-control study[J]. Int J Nurs Stud, 2020,108:103612. DOI URL PMID
[15]	雷盼. 英国国家早期预警评分对急性脑出血患者预后的预测价值[D]. 延安:延安大学, 2018.
	雷盼. 英国国家早期预警评分对急性脑出血患者预后的预测价值[D]. 延安:延安大学, 2018.
	Lei P. The national early warning score predicts the prognosis of patients with acute cerebral hemorrhage[D]. Yan’an:Yan’an University, 2018.
	Lei P. The national early warning score predicts the prognosis of patients with acute cerebral hemorrhage[D]. Yan’an:Yan’an University, 2018.
[16]	张君先. 妇产科急腹症的临床疗效观察[J]. 中国医药指南, 2016,14(2):132.
	张君先. 妇产科急腹症的临床疗效观察[J]. 中国医药指南, 2016,14(2):132.
	Zhang JX. Observation of clinical efficacy of acute abdomen in obstetrics and gynecology[J]. Guid Chin Med, 2016,14(2):132.
	Zhang JX. Observation of clinical efficacy of acute abdomen in obstetrics and gynecology[J]. Guid Chin Med, 2016,14(2):132.
[17]	徐凌燕, 项珍珍, 刘根红, 等. 产科分娩患者急诊分诊指标的适用性研究[J]. 中华急诊医学杂志, 2017,26(3):343-346.
	徐凌燕, 项珍珍, 刘根红, 等. 产科分娩患者急诊分诊指标的适用性研究[J]. 中华急诊医学杂志, 2017,26(3):343-346.
	Xu LY, Xiang ZZ, Liu GH, et al. Applicability study of emergency triage index for obstetric delivery patients[J]. Chin J Emerg Med, 2017,26(3):343-346.
	Xu LY, Xiang ZZ, Liu GH, et al. Applicability study of emergency triage index for obstetric delivery patients[J]. Chin J Emerg Med, 2017,26(3):343-346.
[18]	邢焕民, 吕冬梅, 王晓慧, 等. 术后谵妄风险预测模型的构建及应用[J]. 中华护理杂志, 2019,54(1):8-13.
	邢焕民, 吕冬梅, 王晓慧, 等. 术后谵妄风险预测模型的构建及应用[J]. 中华护理杂志, 2019,54(1):8-13.
	Xing HM, Lü DM, Wang XH, et al. The development and application of a risk prediction model for postoperative delirium in ICU patients[J]. Chin J Nurs, 2019,54(1):8-13.
	Xing HM, Lü DM, Wang XH, et al. The development and application of a risk prediction model for postoperative delirium in ICU patients[J]. Chin J Nurs, 2019,54(1):8-13.
[19]	冯庚. 院前急救时的检伤分类:临床分析要点[J]. 中国全科医学, 2012,15(8):897-898.
	冯庚. 院前急救时的检伤分类:临床分析要点[J]. 中国全科医学, 2012,15(8):897-898.
	Feng G. Classification of injuries during pre-hospital first aid:essentials of clinical analysis[J]. Chin Gen Pract, 2012,15(8):897-898.
	Feng G. Classification of injuries during pre-hospital first aid:essentials of clinical analysis[J]. Chin Gen Pract, 2012,15(8):897-898.
[20]	李恒, 黄子通. 胸外按压质量与心肺复苏效果的研究进展[J]. 中华急诊医学杂志, 2012,21(8):923-926.
	李恒, 黄子通. 胸外按压质量与心肺复苏效果的研究进展[J]. 中华急诊医学杂志, 2012,21(8):923-926.
	Li H, Huang ZT. Research progress on the quality of chest compressions and the effect of cardiopulmonary resuscitation[J]. Chin J Emerg Med, 2012,21(8):923-926.
	Li H, Huang ZT. Research progress on the quality of chest compressions and the effect of cardiopulmonary resuscitation[J]. Chin J Emerg Med, 2012,21(8):923-926.
[21]	Shafi S, Elliott AC, Gentilello L. Is hypothermia simply a marker of shock and injury severity or an independent risk factor for mortality in trauma patients analysis of a large national trauma registry[J]. J Trauma:Inj Infect Crit Care, 2005: 1081-1085.
	Shafi S, Elliott AC, Gentilello L. Is hypothermia simply a marker of shock and injury severity or an independent risk factor for mortality in trauma patients analysis of a large national trauma registry[J]. J Trauma:Inj Infect Crit Care, 2005: 1081-1085.
[22]	林力. 不同材质冰袋对高热大鼠物理降温时效的效果研究[D]. 福州:福建医科大学, 2016.
	林力. 不同材质冰袋对高热大鼠物理降温时效的效果研究[D]. 福州:福建医科大学, 2016.
	Lin L. Ice bag made of different materials research on the physical cooling effects of heat aging rats[D]. Fuzhou:Fujian Medical University, 2016.
	Lin L. Ice bag made of different materials research on the physical cooling effects of heat aging rats[D]. Fuzhou:Fujian Medical University, 2016.
[23]	牟婧祎. 妇科急性腹痛的病因分析及鉴别诊断[J]. 中国继续医学教育, 2014,6(6):37-38.
	牟婧祎. 妇科急性腹痛的病因分析及鉴别诊断[J]. 中国继续医学教育, 2014,6(6):37-38.
	Mou JY. Etiological analysis and differential diagnosis of acute abdominal pain in gynecology[J]. Chin Conti Med Educ, 2014,6(6):37-38.
	Mou JY. Etiological analysis and differential diagnosis of acute abdominal pain in gynecology[J]. Chin Conti Med Educ, 2014,6(6):37-38.
[24]	陈震宇, 蒋艺莎, 金珈汐, 等. 以血常规指标的变化评估产后出血量的临床研究[J]. 中国妇幼保健, 2018,33(7):1480-1483.
	陈震宇, 蒋艺莎, 金珈汐, 等. 以血常规指标的变化评估产后出血量的临床研究[J]. 中国妇幼保健, 2018,33(7):1480-1483.
	Chen ZY, Jiang YS, Jin JX, et al. Clinical study on the evaluation of postpartum hemorrhage by changes in blood routine indexes[J]. Matern Child Heal Care Chin, 2018,33(7):1480-1483.
	Chen ZY, Jiang YS, Jin JX, et al. Clinical study on the evaluation of postpartum hemorrhage by changes in blood routine indexes[J]. Matern Child Heal Care Chin, 2018,33(7):1480-1483.
[25]	王灵, 杨勇灵, 王万灵. 乳酸与中心静脉血氧饱和度的比值对休克患者病情的判断价值[J]. 天津医药, 2016,44(3):360-362.
	王灵, 杨勇灵, 王万灵. 乳酸与中心静脉血氧饱和度的比值对休克患者病情的判断价值[J]. 天津医药, 2016,44(3):360-362.
	Wang L, Yang YL, Wang WL. Clinical value of the ratio of lactic acid divided by central venous oxygen saturation for patients with shock[J]. Tianjin Med J, 2016,44(3):360-362.
	Wang L, Yang YL, Wang WL. Clinical value of the ratio of lactic acid divided by central venous oxygen saturation for patients with shock[J]. Tianjin Med J, 2016,44(3):360-362.
[26]	吴淼星, 吴新枝, 李文洲. 532例妇科急腹症临床分析[J]. 中国卫生标准管理, 2019,10(19):41-45.
	吴淼星, 吴新枝, 李文洲. 532例妇科急腹症临床分析[J]. 中国卫生标准管理, 2019,10(19):41-45.
	Wu MX, Wu XZ, Li WZ. Analysis on diagnosis and treatments of 532 gynecological acute abdomens patients[J]. Chin Heal Stand Manag, 2019,10(19):41-45.
	Wu MX, Wu XZ, Li WZ. Analysis on diagnosis and treatments of 532 gynecological acute abdomens patients[J]. Chin Heal Stand Manag, 2019,10(19):41-45.
[27]	沈洪兵. 流行病学:双语[M]. 北京:人民卫生出版社, 2009.
	沈洪兵. 流行病学:双语[M]. 北京:人民卫生出版社, 2009.
	Shen HB. Epidemiology:Bilingualism[M]. Beijing:People’s Medical Publishing House, 2009.
	Shen HB. Epidemiology:Bilingualism[M]. Beijing:People’s Medical Publishing House, 2009.
[28]	郭一伶. 卵巢黄体破裂32例临床诊治分析[J]. 山西医药杂志, 2016,45(12):1457-1458.
	郭一伶. 卵巢黄体破裂32例临床诊治分析[J]. 山西医药杂志, 2016,45(12):1457-1458.
	Guo YL. Analysis of clinical diagnosis and treatment of 32 cases of ruptured corpus luteum[J]. Shanxi Med J, 2016,45(12):1457-1458.
	Guo YL. Analysis of clinical diagnosis and treatment of 32 cases of ruptured corpus luteum[J]. Shanxi Med J, 2016,45(12):1457-1458.