应用危重病例评分法预测PICU患儿的预后  

Prognosis prediction in patients admitted to PICU by using pediatric critical illness score

作　　者：耿荣[1] 樊寻梅[1] 陈贤楠[1] 于毅 田宏[1] 齐宇洁[1] 李耿[1] 陈晖[1] 王雷[1] 

机构地区：[1]首都医科大学附属北京儿童医院,100045

出　　处：《中华儿科杂志》1999年第9期533-535,共3页Chinese Journal of Pediatrics

摘　　要：目的　应用国内儿科危重病例评分法（ＰＣＩＳ）评价儿科ＩＣＵ（ＰＩＣＵ） 患儿的病情危重度，预计病死风险率，探讨死亡相关因素。方法　对１９９６ 年１ 月～１９９７ 年１２ 月ＰＩＣＵ 的６５０ 例住院患儿进行ＰＣＩＳ评分和资料分析。用ＳＡＳ统计软件，进行单因素分析和逐步Ｌｏｇｉｓｔｉｃ 回归筛选变量分析，根据评分值建立病死风险率预计公式１ ，并观察预计模型的准确性和对个体预后的判断能力。结果　死亡９７ 例，病死率１４．９ ％ 。评分值、基础疾病、心跳呼吸骤停、脏器衰竭数目、院内感染、住院日数和是否来源于其他病房与死亡密切相关（ Ｐ均＜ ０．０５） 。死亡独立危险因素为心跳呼吸骤停和脏器衰竭数目。根据入ＰＩＣＵ最初２４ 小时的最低评分值建立病死风险率预计公式：Ｌｏｇｉｔ（ｐ） ＝ ８．３９４ － ０．１２３ ×评分值，敏感度、特异性和阳性预计值分别为４３．３％ 、９４．９％ 和７７．２％ 。结论　（１）ＰＣＩＳ适用于ＰＩＣＵ 评估患儿病情危重度和个体病死风险率。（２）所得预计模型适合ＰＩＣＵ 近期应用。（３） 防止和减少心跳呼吸骤停的发生是降低病死风险率的关键。Objective To evaluate the severity of illness, the risk factors and prognosis of patients admitted to PICU in Beijing Children′s Hospital. Methods Severity of illness and clinical features of 650 patients admitted to PICU were prospectively studied by using pediatric critical illness score (PCIS) from January, 1996 to December, 1997. Simple factors and stepwise logistic regression analysis were used to identify risk factors associating with hospital mortality. The predictive model of probability of dying was established to the score. Results The overall mortality rate of the patients during that period was 15%. The formula for predicting probability of dying was Logit (p)=8.394-0.123×(score). Multivariate analysis identified the following risk factors: cardiac and respiratory arrest and the number of multiple system organ failure. Conclusion PCIS might be used to evaluate the severity of illness accurately in children admitted to PICU in Beijing Children′s Hospital. The formula may be valuable for evaluating the prognosis in our department at present. The keys for increasing prognosis are the prevention of cardiac and respiratory arrest and the support of early respiratory and hemodynamis.

关 键 词：危重病例评分 加强医疗病房 儿科 PICU 预后 

分 类 号：R720.1[医药卫生—儿科]