国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2020, Vol. 39 ›› Issue (1): 30-34.

• 论著 • 上一篇    下一篇

产科早期预警评分系统应用于产科ICU患者的评估

彭兰，吴晓，柴利强   

  1. 215000  苏州市立医院本部暨南京医科大学附属苏州医院
  • 收稿日期:2019-10-15 修回日期:2019-11-26 出版日期:2020-01-15 发布日期:2020-01-15
  • 通讯作者: 柴利强，E-mail：chailiqiang888@126.com E-mail:chailiqiang888@126.com
  • 基金资助:
    江苏省妇幼健康科研项目（F201767）

Application of Obstetric Early Warning Score in Obstetric ICU-Admitted Patients

PENG Lan，WU Xiao，CHAI Li-qiang   

  1. Suzhou Municipal Hospital，Suzhou 215000，Jiangsu Province，China
  • Received:2019-10-15 Revised:2019-11-26 Published:2020-01-15 Online:2020-01-15
  • Contact: CHAI Li-qiang，E-mail：chailiqing888@126.com E-mail:chailiqiang888@126.com

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摘要： 目的：综合评估英国国家重症监护审计和研究中心（ICNARC）-产科早期预警评分（OEWS）系统对入住重症监护病房（ICU）孕产妇发生产科危重症的预测能力。方法：对2015年1月—2018年5月苏州市立医院本部（我院）入住ICU孕产妇共214例进行回顾性队列研究，采用入ICU 24 h内的数据计算OEWS分值，预测其住院期间发生产科危重症的可能性，综合评估ICNARC-OEWS的性能、区分度和分层能力。结果：研究期间，共有67 148例孕妇在我院分娩，其中214例孕产妇入住ICU，ICU入住率3.19/1 000，其中2例死亡，孕产妇死亡率为2.98/100 000，97例发生危重症，危重症发生率为1.44/1 000。最常见的入住ICU原因为直接产科因素（74.3%，159/214）。发生产科危重症的孕产妇OEWS评分显著高于无危重症孕产妇[7（6，9） vs. 4（1，5），Z=－10.340，P=0.000]。OEWS评分为0分的孕产妇无产科危重症发生，1～3分时阴性预测值（NPV）为94.5%（52/55），≥6分时阳性预测值（PPV）为79.0%（83/105）。OEWS区分产科危重症的受试者工作特征（ROC）曲线下面积（AUC）为0.908（95%CI：0.870～0.946，P＜0.001），预测因间接和直接产科因素入住ICU孕产妇发生危重症的AUC分别为0.875（95%CI：0.784～0.966）和0.920（95%CI：0.879～0.961，P＜0.001）。结论：ICNARC-OEWS系统对于ICU孕产妇发生产科危重症具有良好的区分能力和分层能力，可以在ICU的围生期妇女中推广。

关键词: 产科早期预警评分系统, 重症监护病房, 危重症监护结局, 孕妇, 预测

Abstract: Objective：To evaluate the efficiency of the obstetric early warning score (OEWS) from Intensive Care National Audit and Research Centre（ICNARC）Case Mix Program（CMP）（ICNARC-OEWS） for predicting the obstetric critical diseases in peripartal women who admitted to intensive care unit (ICU). Methods: This is a retrospective cohort study on the peripartal women who admitted to ICU with direct and indirect obstetric-related causes at Suzhou Municipal Hospital from Jan 2015 to May 2018. According to ICNARC-OEWS, the score was calculated on the basis of the clinical data collected during the first 24 hours of ICU admission. The aggregate performance of ICNARC-OEWS in predicting the discrimination and risk stratification was evaluated. Results: During the study period, 67 148 deliveries were recorded. There were 214 women who admitted to obstetric ICU, with the rate of ICU admission 3.19/1 000. In total, there were 2 maternal death and 97 severe maternal morbidity, with the rates of the mortality and sever morbidity 2.98/100 000 and 1.44/1 000 respectively. The most frequent causes of ICU admission were the direct obstetrical-related conditions. The OEWS score was significantly higher in women with severe morbidity than those without [7 (6, 9) vs. 4 (1, 5)，Z=－10.340, P=0.000]. Peripartal women with normal OEWS had 0% severe morbidity. The negative predictive value (NPV) in women with 1-3 score of OEWS was 94.5% (52/55), while the positive predictive value (PPV) in women with ≥6 score of OEWS was 79% (83/105). The area under curve (AUC) of the receiver operating characteristic curve (ROC) based on OEWS was used to discriminate the severe maternal morbidity with the efficiency of 0.908 (95%CI: 0.870-0.946, P＜0.001). The AUC values were 0.875 (95%CI：0.784-0.966） and 0.920 (95%CI：0.879-0.961）in the ICU-admitted women with indirect factors and those women with direct factors, respectively (P＜0.001). Conclusions: Our results suggested that the performance of ICNARC-OEWS in the discrimination and risk stratification of severe maternal morbidity was good in those obstetric ICU-admitted women, and that the ICNARC-OEWS could be promoted to use in the obstetric ICU-admitted women.

Key words: Obstetric early warning score system, Intensive care units, Critical care outcomes, Pregnant women, Forecasting