护理学报 ›› 2019, Vol. 26 ›› Issue (16): 34-37.doi: 10.16460/j.issn1008-9969.2019.16.034
风险评估和预警工具在心血管系统疾病中临床应用与思考
张庆伟, 杨巧芳, 于漫
- 华中阜外医院,河南 郑州450003
摘要： 目的 通过对国内外风险评估和预警工具的文献进行研究,为制定心血管系统疾病早期预警工具提供依据。方法 对国内外风险评估和预警工具进行文献检索、整理和分析。结果 目前,临床有心血管系统疾病相关研究的危急重症常用的评估工具有：改良早期预警评分、急性生理学及慢性健康状况评分系统等,心血管系统疾病特异性评估表有针对无症状成人冠状动脉粥样硬化性心脏病并发风险的、针对急性冠脉综合征患者的、针对心脏手术风险的评估工具3大类。结论 现有的心血管系统疾病特异性风险评估和预警工具评估内容较多,不易获得,不够简便,不能适用情况复杂的病房需求,而危急重症常用的风险评估和预警工具虽然简便,评估内容易获得,但在心血管疾病领域仍需要进行临床验证、研究和改良。构建心血管系统疾病的早期预警工具是下一步研究方向。
中图分类号:
- R473.54
| [1] 厉小燕. 五种职业健康风险评估方法的应用研究[D].杭州:浙江大学劳动卫生与环境卫生学, 2014. [2] Truett J, Cornfield J, Kannel W.A Multivariate Analysis of the Risk of Coronary Heart Disease in Framingham[J]. J Chronic Dis, 1967,20(7):511-524. [3] Dhaliwal S S, Welborn T A, Howat P A.Recreational Physical Activity as an independent Predictor of Multivariable Cardiovascular Disease Risk[J]. PLoS One, 2013, 8(12):e83435.DOI:10.1371/journal.pone.0083435. [4] Deo S S, Chogle A R, Mistry K J, et al.increased Prevalence of Subclinical Atherosclerosis in Rheumatoid Arthritis Patients of indian Descent[J]. Exp Clin Cardiol, 2012,17(1):20-25. [5] D'Agostino R S, Vasan R S, Pencina M J, et al. General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study[J]. Circulation, 2008,117(6):743-753.DOI:10.1161/CIRCULATIONAHA.107.699579. [6] 袁绍华,张新超. 心血管疾病风险评估方法及存在问题[J]. 中国心血管杂志, 2011, 16(3):223-226.DOI:10.3969/j.issn.1007-5410.2011.03.019. [7] Wilson P W, D'Agostino R B, Levy D, et al. Prediction of Coronary Heart Disease Using Risk Factor Categories[J]. Circulation, 1998,97(18):1837-1847. [8] Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation,Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)[J]. and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)[J]. JAMA, 2001,285(19):2486-2497. [9] Conroy R M, Pyörälä K, Fitzgerald A P,et al.Estimation of Ten-year Risk of Fatal Cardiovascular Disease in Europe: The SCORE Project[J]. Eur Heart J, 2003,24(11):987-1003. [10] 王薇,赵冬,刘静,等. 中国35~64岁人群心血管病危险因素与发病危险预测模型的前瞻性研究[J]. 中华心血管病杂志,2003,31(12):902-908.DOI:10.3760/j:issn:0253-3758.2003.12.006. [11] Granger C B, Goldberg R J, Dabbous O, et al.Predictors of Hospital Mortality in the Global Registry of Acute Coronary Events[J]. Arch Intern Med, 2003, 163(19):2345-2353.DOI:10.1001/archinte.163.19.2345. [12] Antman E M, Cohen M, Bernink P J, et al.The TIMI Risk Score for Unstable Angina/Non-ST Elevation MI: A Method for Prognostication and Therapeutic Decision Making[J]. JAMA, 2000,284(7):835-842. [13] Aragam K G, Tamhane U U, Kline-Rogers E, et al.Does Simplicity Compromise Accuracy in ACS Risk Prediction? A Retrospective Analysis of the TIMI and GRACE Risk Scores[J]. PLoS One, 2009,4(11):e7947.DOI:10.1371/journal.pone.0007947. [14] Nashef S A, Roques F, Michel P, et al.European System for Cardiac Operative Risk Evaluation (EuroSCORE)[J]. Eur J Cardiothorac Surg, 1999,16(1):9-13. [15] Parsonnet V, Dean D, Bernstein A D.A Method of Uniform Stratification of Risk for Evaluating The Results of Surgery in Acquired Adult Heart Disease[J]. Circulation, 1989,79(6 Pt 2):I3-I12. [16] Edwards F H, Grover F L, Shroyer A L, et al.The Society of Thoracic Surgeons National Cardiac Surgery Database: Current Risk Assessment[J]. Ann Thorac Surg, 1997,63(3):903-908. [17] Eagle K A, Guyton R A, Davidoff R, et al.ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery: Executive Summary and Recommendations: A Report of The American College of Cardiology/American Heart Association Task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft surgery)[J]. Circulation, 1999,100(13):1464-1480. [18] Higgins T L, Estafanous F G, Loop F D, et al.Stratification of Morbidity and Mortality Outcome by Preoperative Risk Factors in Coronary Artery Bypass Patients. A Clinical Severity Score[J]. JAMA, 1992,267(17):2344-2348. [19] Knaus W A, Draper E A, Wagner D P, et al.APACHE II: A Severity of Disease Classification System[J]. Crit Care Med, 1985,13(10):818-829. [20] Zimmerman J E, Kramer A A, McNair D S, et al. Intensive Care Unit Length of Stay: Benchmarking Based on Acute Physiology and Chronic Health Evaluation (APACHE) IV[J]. Crit Care Med, 2006, 34(10):2517-2529.DOI:10.1097/01.CCM.0000240233.01711.D9. [21] 王娱. APACHE-II和APACHE-IV在心血管病的应用[D]. 北京:北京协和医学院,中国医学科学院,清华大学医学部,北京协和医学院(中国医学科学院)内科学, 2011. [22] Morgan R J M, Williams F, Wright M M. An Early Warning Scoring System for Detec-ting Developing Critical Illness[J]. Clin Intens Care,1997,8(2):100-114. [23] Subbe C P, Kruger M, Rutherford P, et al.Validation of a Modified Early Warning Score in Medical Admissions[J]. QJM, 2001,94(10):521-526.DOI:10.1093/qjmed/94.10.521. [24] 王承辉,阮海林,杨春旭,等. 院前急救患者的改良早期预警评分分布及应用的临床研究[J]. 中国急救医学, 2011,31(4):310-313.DOI:10.3969/j.issn.1002-1949.2011.04.007. [25] 梁晓梅,陈务贤,李春蓉. 改良早期预警评分对冠心病住院患者病情严重程度及预后的评估价值研究[J]. 护理学报, 2016,23(3):50-52.DOI:10.16460/j.issn1008-9969.2016.03.050. [26] 朱蓓,姜梅,王芝,等. 改良早期预警评分在心脏科门诊预检分诊中的应用[J]. 护士进修杂志, 2013,28(22):2031-2032. [27] 方婷婷. MEWS评分在急诊胸痛患者去向、预后中的应用研究[D].石河子:石河子大学护理学, 2016. [28] 黄勇谋,刘红丽,邓沛立,等. 改良早期预警评分与校正改良早期预警评分在急性左心衰的应用对比研究[J]. 湖南师范大学学报(医学版), 2014(4):31-33. [29] Royal College of Physicians. National Early Warning Score(NEWS):Standardizing the Assessment of Acute-Illness Severity in the NHS.Report of a Working Party[R]. London: Royal College of Physicians, 2012. [30] Smith G B, Prytherch D R, Meredith P, et al.The Ability of the National Early Warning Score (NEWS) to Discriminate Patients at Risk of Early Cardiac Arrest, Unanticipated intensive Care Unit Admission, and Death[J]. Resuscitation, 2013, 84(4):465-470. DOI:10.1016/j.resuscitation.2012.12.016. [31] 李红,吴婷婷,穆艳. 急性冠状动脉综合征患者心搏骤停前24 h早期预警评分变化趋势的研究[J]. 中华护理杂志, 2019,54(1):14-18.DOI:10.3761/j.issn.0254-1769.2019.01.002. [32] 肖红丽,孙芳芳,齐海宇,等. 早期预警评分及其临床应用进展[J]. 中国危重病急救医学, 2009,21(11):697-699.DOI:10.3760/cma.j.issn.10030603.2009.11.024. [33] Nauman N, Hugo M.Beyond The Intensive Care Unit: A Review of Interventions Aimed at Anticipating and Preventing in-Hospital Cardiopulmonary Arrest[J]. Resuscitation, 2005,67(1).DOI:10.1016/j.resuscitation.2005.04.016. [34] C P S, A S, D M, et al.Validation of Physiological Scoring Systems in the Accident and Emergency Department[J]. EMJ,2006,23(11).DOI:10.1136/emj.2006.035816. [35] 陈红,宋俊贤. 心血管风险评估:新指南、新工具[J]. 中国心血管杂志, 2014, 19(5):330-333.DOI:10.3969/j.issn.1007-5410.2014.05.003. [36] Brabrand M, Kellett J.Mobility Measures Should Be Added to the National Early Warning Score (NEWS)[J]. Resuscitation,2014,85(9):e151.DOI:10.1016/j.resuscitation.2014.05.033. [37] 王富文,史俊,施静,等. 以体重为指导的管理和干预对慢性心力衰竭患者心功能的影响[J]. 中华心血管病杂志, 2017, 45(10):874-879.DOI:10.3760/cma.j.issn.0253-3758.2017.10.012. [38] Jo S, Yoon J, Lee J B, et al.Predictive Value of the National Early Warning Score-lactate for Mortality and the Need for Critical Care among General Emergency Department Patients[J]. J Crit Care, 2016,36:60-68.DOI:10.1016/j.jcrc.2016.06.016. |
| [1] | 李杰, 张培莉, 童宇平, 郭冬娜, 张欢. PQRST联合改良早期预警评分快速分诊记录表在急性上腹痛患者分诊中的应用[J]. 护理学报, 2019, 26(3): 70-72. |
| [2] | 林少虹, 林月双, 李春容, 潘愈嘉. MEWS病情自动预警系统的开发与应用[J]. 护理学报, 2019, 26(16): 76-78. |
| [3] | 刘瑞红,张霞,万晶晶,谭文红. 肾移植术后妊娠风险评估研究进展[J]. 护理学报, 2018, 25(2): 33-36. |
| [4] | 吴巧媚,张利娟,郑静霞. 基于Delphi法ICU患者误吸风险评估体系的构建[J]. 护理学报, 2018, 25(2): 1-6. |
| [5] | 胡娟娟,高兴莲,杨英,马琼. 基于手术室护理信息系统的手术压疮风险评估模块的应用[J]. 护理学报, 2018, 25(18): 27-29. |
| [6] | 董玉娇,王爱红,魏素臻,王占聚,肖华. 预警评分工具对恶性血液病化疗粒细胞缺乏期并发感染患者转归的预测效果研究[J]. 护理学报, 2018, 25(17): 1-4. |
| [7] | 黄晓波,韦琴,文燕,李艳青,杨朝霞,梁洁. 早产儿早期预警评分表的编制及信效度检验[J]. 护理学报, 2018, 25(15): 1-5. |
| [8] | 林嘉琪,吴桂丽. Morse跌倒风险评估量表的临床应用研究进展[J]. 护理学报, 2018, 25(13): 42-45. |
| [9] | 赵喜兰,罗晓,黎明,杨国莉. 应用家属版压疮风险评估表对卧床慢性心力衰竭患者家属健康教育的效果观察[J]. 护理学报, 2017, 24(7): 69-71. |
| [10] | 罗斯莉,马莹. 防暴力技能训练和暴力风险评估对精神科职场暴力的影响[J]. 护理学报, 2017, 24(6): 44-47. |
| [11] | 韩斌如,李秋萍. 老年患者手术风险评估工具的应用进展[J]. 护理学报, 2017, 24(24): 31-34. |
| [12] | 孙朋霞(综述),李凡(审校). 改良早期预警评分在国内外急诊患者中的临床应用进展[J]. 护理学报, 2016, 23(3): 36-38,39. |
| [13] | 梁晓梅,陈务贤,李春蓉. 改良早期预警评分对冠心病住院患者病情严重程度及预后的评估价值研究[J]. 护理学报, 2016, 23(3): 50-52. |
| [14] | 刘海燕,周波,郑艳. 急诊呼吸系统疾病患者基于改良早期预警评分的护理干预[J]. 护理学报, 2016, 23(14): 51-53. |
| [15] | 蔡燕颜,姜仁仁. 早期预警评价系统用于基层医院的效果观察[J]. 护理学报, 2015, (2): 76-78. |
|