危重评分预测新生儿坏死性小肠结肠炎预后62例回顾分析  

Predicting outcome in necrotizing enterocolitis with the score for neonatal acute physiology： a retrospective study of 62 cases

作　　者：林慧佳[1] 马晓路[1] 施丽萍[1] 罗芳[1] 杜立中[1] 

机构地区：[1]浙江大学医学院附属儿童医院新生儿重症监护病房,杭州310003

出　　处：《中华儿科杂志》2013年第5期326-330,共5页Chinese Journal of Pediatrics

基　　金：出生缺陷早期筛查与干预技术创新团队（N20110661-02）;浙江省教育厅项目（Y200908620）

摘　　要：摘 要：目的 探索新生儿急性生理学评分Ⅱ（SNAP-Ⅱ）和新生儿紧急生理学评分围产期补充-Ⅱ（SNAPPE-Ⅱ）预测新生儿坏死性小肠结肠炎（NEC）手术风险及预后的价值.方法 2001年10月至2011年10月对浙江大学医学院附属儿童医院新生儿重症监护室,收治的62例NEC患儿进行回顾性分析,按照是否接受手术分为手术组和非手术组,按预后分为存活组和死亡组.统计患儿的一般资料、早期症状、实验室检查、治疗方法、预后,并根据每例患儿诊断NEC当日的指标进行SNAP-Ⅱ和SNAPPE-Ⅱ评分.结果 腹胀是NEC早期最常见症状,占91.9％ （57/62）,其次常见症状包括胃潴留、血便等.手术组的SNAP-Ⅱ和SNAPPE-Ⅱ评分（26.5、26.5）高于非手术组（13.0、13.0）（P=0.002、0.006）,死亡组的SNAP-Ⅱ和SNAPPE-Ⅱ评分（29、32）高于存活组（8、8）（P=0.000、0.000）.SNAP-Ⅱ和SNAPPE-Ⅱ评分预测手术的工作特征曲线（ROC）及曲线下面积（AUC）分别为0.745和0.714,SNAP-Ⅱ和SNAPPE-Ⅱ评分预测死亡的ROC曲线AUC分别为0.916和0.929.SNAP-Ⅱ和SNAPPE-Ⅱ评分预测手术的最佳值分别为22和28,预测死亡风险的最佳值分别为19和22.结论 SNAP-Ⅱ及SNAPPE-Ⅱ评分作为疾病严重度的指标,能预测NEC的预后及手术风险,对NEC诊断早期预测其死亡危险性有重要意义.Objective To explore the value of the score for neonatal acute physiology （score for neonatal acute physiology,SNAP） in predicting outcome and risk of surgery of necrotizing enterocolitis （NEC）.Method A total of 62 NEC patients in neonatal intensive care unit （NICU） of Zhejiang University Children＇s Hospital were reviewed from October 2001 to October 2011.All the patients were classified into surgery group and non-surgery group according to whether the patient had the surgical intervention.Also the patients were divided into death group and alive group according to the outcome.Data on gestational age at birth,gender,birth weight,early clinical manifestations,treatment and prognosis of all patients were collected.SNAP-Ⅱ and score for neonatal acute physiology and perinatal extension Ⅱ （SNAPPE-Ⅱ） were calculated on the day of diagnosis.Result Abdominal distension,which was seen in 91.9% of the cases,was the commonest early clinical manifestation.The next was residual and bloody stool.SNAP-Ⅱ and SNAPPE-Ⅱ score in surgery group （26.5,26.5） were higher than that of the non-surgery group （13.0,13.0,P =0.002,0.006）.And the same scores in death group（29.0,32.0）were higher than those in the alive group （8.0,8.0） （P =0.000,0.000）.Measuring the scores as a predictor of surgery,the area under ROC curve for SNAP-Ⅱ was 0.745,and was 0.714 for SNAPPE-Ⅱ.The area under ROC curve for SNAP-Ⅱ was 0.916,and was 0.929 for SNAPPE-Ⅱ.The best positive point of SNAP-Ⅱ and SNAPPE-Ⅱ for predicting surgery was 22 and 28.The best positive point of SNAP-Ⅱ and SNAPPE-Ⅱ for predicting death was 18.5 and 22.Conclusion The SNAP-Ⅱ and SNAPPE-Ⅱ score may be used to predict the prognosis and the risk of surgery in the NEC patients.The scores are also good predictors of mortality in the early period when NEC occurs. Keywords：Enterocolitis necrotizing;Infant,newborn

关 键 词：小肠结肠炎 坏死性 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]