【作者】 刘瑜；

【导师】 李振香；

【作者基本信息】 山东大学 ， 护理（专业学位）， 2018， 硕士

【摘要】 研究目的探讨MEWS评分和急诊科患者院内转运过程中不安全事件的相关性,研究MEWS评分在急诊患者院内转运中应用的价值和可行性,为确保急诊患者院内安全转运寻找可靠的风险评估工具。研究方法选取本地区省级某三级甲等医院自2017年5月至2017年10月在急诊科经抢救后需要行院内转运的患者共300例进行前后对照研究。其中,收集自2017年5月至2017年7月在我院急诊科抢救后需行院内转运的患者共150例,将其设置为对照组,并收集自2017年8月至2017年10月在我院急诊科抢救后需行院内转运的患者共150例,将其设置为试验组。对照组的患者采用常规凭临床经验评估后转运,试验组的患者采用MEWS评分系统进行风险评估,并根据评分情况在转运中采取不同护理措施。观察两组患者在转运中不安全事件的发生情况,并进行比较。结果1.试验组患者在院内转运期间不安全事件的总发生率比对照组的明显降低(P<0.05),试验组患者的血氧饱和度降低、意识改变、窒息或呼吸困难、血压骤降或休克、心律失常和死亡的发生率均比对照组的明显降低(P<0.05)。2.在两组中不同疾病类型患者的不安全事件发生率比较差异无统计学意义(P>0.05),呼吸系统疾病和心血管系统疾病的不安全事件发生率比其他类型疾病患者的明显增加(P<0.05)。3.两组中转运到ICU的患者不安全事件发生率比其他三种转运场所的明显增加(P<0.05)。在试验组中,经MEWS评分,转运到普通病房患者的风险明显低于转运到手术室和检查科室(P<0.05);在对照组中,转运到普通病房患者的不安全事件发生率比转运到手术室和检查科室的明显减少(P<0.05)。4.在试验组中,患者经MEWS评分的风险程度与转运不安全事件的发生率呈明显的正向相关性(r=0.633,P<0.05),即MEWS评分风险程度越高,不安全事件发生率越高。MEWS评分在评估急诊科患者院内转运风险的ROC曲线下面积为0.730,特异性是78.51%,灵敏度是60.2%。结论1.根据MEWS评分的风险程度,采取不同的护理措施,能够降低急诊科危重症患者在院内转运期间不安全事件的发生率,从而减少转运风险。2.急诊科呼吸系统疾病和心血管系统疾病的危重症患者在院内转运期间存在较高的转运风险性。3.目的场所为ICU的危重患者在院内转运期间存在较高的转运风险性,而运送到普通病房患者的转运风险性偏低。4.MEWS评分在评估急诊科患者院内转运风险时存在较高的灵敏度和特异性。更多还原

【Abstract】 Research objectivesObjective To explore the correlation between MEWS score and unsafe events in the hospital during emergency transportation,and to study the value and feasibility of MEWS score in the transportation of emergency patients,in order to ensure the safe transportation of emergency patients,a reliable risk assessment tool is sought.Research methodsA total of 300 patients who had to be transported in the emergency department after the emergency department were rescued from May 2017 to October 2017 were selected from the provincial level three grade A hospitals in this area.Among them,150 patients who had to be transported in the emergency department of our hospital from May 2017 to July 2017 were set up as the control group and 150 patients who had to be transported in the emergency department from August 2017 to October 2017 were collected and set up as the experimental group.The patients in the control group used the routine clinical experience to evaluate the transshipment.The patients in the experimental group were evaluated by the MEWS scoring system,and the different nursing measures were taken in transit according to the score.The occurrence of unsafe events in the two groups were observed and compared.Results1.The incidence of unsafe events of patients in the study group during the transfer was significantly lower than that in the control group(P<0.05).The rate of blood oxygen saturation decreased,altered consciousness,suffocation or dyspnea,drop in blood pressure or shock,arrhythmia and death in the study group were lower significantly than that in the control group(P<0.05).2.The incidence of unsafe events in different type of disease in the two groups was not statistically significant(P>0.05).The incidents of unsafe events patients with respiratory diseases and cardiovascular system diseases were significantly higher than those with other types of diseases(P<0.05).3.The incidence of unsafe events with transported to ICU in the two groups were higher significantly than those with transported to the other three transport sites(P<0.05).MEWS scores of patients transported to the general ward in the study group were significantly lower than those with transported to the operation room and inspection department(P<0.05).The incidence of unsafe events with transported to general ward in the control group was lower significantly than that with transported to the operation room and inspection department(P<0.05).4.In the study group,MEWS score of patients with rate of unsafe events had the significant positive correlation(r=0.633,P<0.05),and the ROC curve area of MEWS score in the evaluation the emergency transport risk was 0.730(SE=0.035,95%CI=0.643-0.714).The specificity was 78.51%,and sensitivity was 60.2%.Conclusions1.The MEWS score can be reduced incidence of unsafe events of emergency patients during the transport in the hospital.2.The patients with respiratory and cardiovascular diseases at the emergency department had higher risk during hospital transport.3.There is the high risk in patients with transported to ICU in hospital,and the risk of transporting to general ward is low.4.The MEWS score has the high sensitivity and specificity in assessing the risk of hospital transport at the emergency department.更多还原