目的 探讨基于改良早期预警评分(modified earlyvarning score，MEWS)系统的分级急救护理在急性胰腺炎患者急救中的应用效果。方法 选取南阳市第一人民医院西区医院2021年6月至2023年6月收治的140例行急救治疗的急性胰腺炎患者进行随机对照试验。采用随机数字表法将其分为常规急救组(70例)和分级急救组(70例)。常规急救组男32例，女38例，年龄29～73(49。22±5。34)岁，病程1～20(13。03±2。46)h，采用常规急救护理。分级急救组男37例，女33例，年龄31～76(50。19±5。72)岁，病程1～21(13。42±2。55)h，在常规急救护理的基础上实施基于MEWS系统的分级急救护理。比较两组临床症状改善情况、病情程度生化指标[血清淀粉酶(amylase，AMY)、C反应蛋白(C-reactive protein，CRP)、降钙素原(procalcitonin，PCT)]、心理状态[焦虑自评量表(Self-Rating Anxiety Scale，SAS)、抑郁自评量表(Self-Rating Depression Scale，SDS)]、健康行为[健康行为自评量表(Self-Rated Abilities for Health Practices Scale，SRAHP)]、并发症情况。统计学方法采用 t 检验、x2检验。结果 分级急救组腹胀消失时间、腹痛消失时间、发热缓解时间分别为(1。54±1。10)d、(3。58±1。47)d、(2。61±1。36)d，均短于常规急救组的(2。31±1。02)d、(5。13±1。33)d、(3。49±1。27)d，差异均有统计学意义(t=4。295、6。542、3。957，均P＜0。05)。干预后，分级急救组AMY、CRP、PCT水平分别为(95。32±6。31)U/L、(29。31±5。49)g/L、(0。22±0。10)μg/L，均低于常规急救组的(108。23±6。57)U/L、(63。17±5。28)g/L、(0。54±0。14)μg/L，差异均有统计学意义(t=11。857、37。192、15。562，均P＜0。05)。干预后，分级急救组SAS、SDS 评分分别为(33。52±6。38)分、(34。46±6。84)分，低于常规急救组的(49。16±6。52)分、(41。24±6。11)分，SRAHP评分为(89。20±6。44)分，高于常规急救组的(72。62±6。15)分，差异均有统计学意义(t=14。345、6。185、15。578，均P＜0。05)。干预期间，分级急救组并发症发生率为4。29％(3/70)，低于常规急救组的15。71％(11/70)，差异有统计学意义(x2=5。079，P＜0。05)。结论 将基于MEWS系统的分级急救护理用于急救治疗的急性胰腺炎患者中，能有效改善患者临床症状，加快患者康复进程，减轻患者心理应激反应，改善病情，提高救治效果。
Application of graded emergency nursing based on MEWS scoring system in emergency treatment for patients with acute pancreatitis
Objective To explore the effect of graded emergency nursing based on modified early warning score(MEWS)system in emergency treatment for patients with acute pancreatitis.Methods One hundred and forty patients with acute pancreatitis who underwent emergency treatment in West District Hospital,Nanyang First People's Hospital from June 2021 to June 2023 were selected for the randomized controlled trial,and were divided into a routine emergency group(70 cases)and a graded emergency group(70 cases)by the random number table method.There were 32 males and 38 females in the routine emergency group;they were 29-73(49.22±5.34)years old;their disease course was 1-20(13.03±2.46)h;they received routine emergency nursing.There were 37 males and 33 females in the graded emergency group;they were 31-76(50.19±5.72)years old;their disease course was 1-21(13.42±2.55)h;they received routine emergency nursing and graded emergency care based on the MEWS system.The improvement of clinical symptoms,biochemical indicators of disease degree[serum amylase(AMY),C-reactive protein(CRP),and procalcitonin(PCT)],mental state[Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)],scores of Self-Rated Abilities for Health Practices Scale(SRAHP),and complications were compared between the two groups.t and x2 tests were applied.Results The times for disappearance of abdominal distension,abdominal pain,and fever in the graded emergency group were(1.54±1.10)d,(3.58±1.47)d,and(2.61±1.36)d,respectively,which were shorter than those in the routine emergency group[(2.31±1.02)d,(5.13±1.33)d,and(3.49±1.27)d],with statistical differences(t=4.295,6.542,and 3.957;all P＜0.05).After the intervention,the levels of AMY,CRP,and PCT in the graded emergency group were(95.32±6.31)U/L,(29.31±5.49)g/L,and(0.22±0.10)μg/L,respectively,which were lower than those in the routine emergency group[(108.23±6.57)U/L,(63.17±5.28)g/L,and(0.54±0.14)μg/L],with statistical differences(t=11.857,37.192,and 15.562;all P＜0.05).After the intervention,the scores of SAS and SDS in the graded emergency group were(33.52±6.38)and(34.46±6.84),which were lower than those in the routine emergency group[(49.16±6.52)and(41.24±6.11)];the score of SRAHP in the graded emergency group was higher than that in the routine emergency group[(89.20±6.44)vs.(72.62±6.15);there were statistical differences(t=14.345,6.185,and 15.578;all P＜0.05).During the intervention period,the incidence of complications in the graded emergency group was lower than that in the routine emergency group[4.29％(3/70)vs.15.71％(11/70)],with a statistical difference(x2=5.079;P＜0.05).Conclusion Graded emergency nursing based on MEWS system for patients with acute pancreatitis can effectively improve their clinical symptoms,speed up their rehabilitation,reduce their psychological stress reaction,and improve their conditions and the treatment effect.
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维普
