小儿危重病例评分和死亡指数在急性呼吸窘迫综合征中的应用  

Assessment of pediatric critical index score and pediatric index of mortality in pediatric acute respiratory distress syndrome

作　　者：李耿[1] 喻文亮[2] 于学军 钱素云[1] 孙波[2] 

机构地区：[1]首都医科大学附属北京儿童医院,北京100045 [2]上海复旦大学附属上海儿科医院 [3]清华大学第一附属医院北京华信医院

出　　处：《中华急诊医学杂志》2007年第5期518-521,共4页Chinese Journal of Emergency Medicine

基　　金：美国中华医学基金会(03-786)

摘　　要：目的探讨小儿危重病例评分(PCIS)和小儿死亡指数(PIM)在急性呼吸窘迫综合征(ARDS)的中适用性。方法应用PCIS及PIM对临床流行病学调查中符合1994年欧美联席会议定义的ARDS患儿进行评分,选取4个时段,即入PICU 1h、在PICU病情最重时、入选ARDS 1h、ARDS病情最重时的评分结果。PIM直接通过因特网(http://www.sfar.org/scores2/pim22.html)进行计算,根据存活或死亡的临床结果进行分组,比较PCIS及PIM评分结果。统计学处理使用SPSS软件。两组间人口学资料、住院时间及评分的比较使用曼-惠特尼U检验,组间病死率的比较使用x^2检验,以P<0.05为差异具有统计学意义。同时分别建立两种评分法相应的受试者工作特征曲线(ROC curve),该曲线下的面积(AUC)是评估评分法分辨能力的重要参数,该值≥0.75被认为有临床意义。结果存活组与死亡组ARDS病情最重时PCIS(P=0.006)及PIM(P=0.013)评分之间差异具有统计学意义。入选ARDS 1h的PIM评分差异具有统计学意义(P=0.031)。各时段PCIS与PIM的ROC曲线下面积均小于0.75。结论PCIS和PIM虽然对评估ARDS病情的严重程度及发展趋势有一定帮助,也可初步判断预后好坏,但对预测死亡风险的价值仍然有限。Objective To evaluate feasibility of a domestic Pediatric Critica/Index Score （PCIS） and Pediatric Index of Mortality （PIM） in pediatric ARDS in China. Method PCIS and PIM were applied to ARDS children at four particular moments. Patients were grouped according to the outcome. PCIS and PIM could be used as criteria for comparison between groups. The ROC curves of PCIS and PIM at different moments were conducted, The area under the curve （AUC） was calculated. Results There were significant difference of PCIS and PIM when children got severe situation in PICU （P = 0.006 and P = 0.013, respectively）. There was significant difference between survived and dead patients after one hour ARDS diagnosed （P = 0.031 ）. All AUC at different moments were less than 0.75. Conclusions Both PCIS and PIM can be useful for evatuating severity and trend of the ARDS children. But the predictive value of relavent outcome were limited.

关 键 词：急性呼吸窘迫综合征 小儿危重病例评分 小儿死亡指数 

分 类 号：R720.597[医药卫生—急诊医学]