修正休克指数在急诊病情判断中的作用研究

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目的研究修正休克指数(MSI)及传统生命体征评估指标与急诊分诊时进入抢救室患者比例的相关性,探讨其对急诊分诊的意义和优势。方法回顾性纳入2009年1月1日-5月31日就诊于北京协和医院急诊科,经急诊分诊护士测量并记录生命体征的患者22 153例次,计算相应休克指数(SI)、平均动脉压(MAP)、MSI,估计MSI参考值范围;按MSI参考值范围分组后,比较各组间进入抢救室的患者比例;按脉搏、收缩压、SI、MAP、MSI不同分组,分别计算各组患者进入抢救室所占比例,并计算阳性预测值、阴性预测值及比值比(OR)。结果 MSI参考值范围约为0.34~1.70次/(min·mm Hg)(1 mm Hg=0.133 k Pa);阳性预测值:MSI(16.239%)>MAP(6.115%)>脉搏(5.746%)>收缩压(5.321%)>SI(3.689%);阴性预测值:五者接近且均较高。OR值:MSI(6.138)>MAP(2.498)>脉搏(2.431)>收缩压(2.117)>SI(1.361)。结论脉搏、收缩压、SI、MAP、MSI值与急诊分诊时进入抢救室患者比例存在相关性,可以作为指导急诊分诊的指标,其中MSI可能更优。 Objective To study the correlativity between the indexes of modified shock index (MSI) and traditional vital signs and the proportion of patients entering the emergency room during emergency triage, and to explore the significance and advantages of MSI and emergency triage. Methods Retrospectively included 22 153 patients who were treated at the emergency department of Peking Union Medical College Hospital from January 1 to May 31, 2009, and the vital signs were recorded and recorded by emergency triage nurses. The corresponding shock index (SI), mean arterial pressure (MAP), MSI, and estimated MSI reference value. The proportion of patients who entered the emergency room after the MSI reference range was compared. The different groups were calculated according to pulse, systolic pressure, SI, MAP and MSI. The proportion of patients entering the emergency room and the positive predictive value, negative predictive value and odds ratio (OR) were calculated. Results The MSI reference values ​​ranged from 0.34 to 1.70 times / (min · mm Hg) (1 mm Hg = 0.133 k Pa); the positive predictive value was MSI (16.239%)> MAP (6.115%)> pulse (5.746% Systolic blood pressure (5.321%)> SI (3.689%); negative predictive value: five close and higher. OR values: MSI (6.138)> MAP (2.498)> pulse (2.431)> systolic blood pressure (2.117)> SI (1.361). Conclusion The correlation between pulse rate, systolic blood pressure, SI, MAP, MSI and the proportion of patients entering the emergency room during emergency triage may be used as an index to guide emergency triage. MSI may be superior.
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