几种重症评分在儿科的临床应用  

Application of several severity scoring systems in pediatrics

作　　者：陆文峰[1] 王丽杰[1] 刘春峰[1] 张洁[1] 

机构地区：[1]中国医科大学附属盛京医院PICU,沈阳110004

出　　处：《中国小儿急救医学》2015年第10期714-717,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨与分析急性生理学及慢性健康状况评分系统（acute physiology and chronic health evaluationⅡ , APACHE Ⅱ ）序贯器官衰竭估计评分（sequential organ failure assessment，SOFA）、小儿死亡风险评分（pediatricriskofmortalityscore，PRISM）、小儿危重病例评分（pediatric critical illness score，PCIS）、小儿死亡指数（paediatric index of mortality，PIM）5种常用的评分系统在儿科重症病例中判断病情轻重、评估预后的效果；同时筛选出适用于我院PICU的危重症评分。方法选取2013年1月至2014年12月我院PICU全部院内死亡病例42例为死亡组，选取存活（或治愈）患儿444例为存活组，分别予评估入院时APACHEⅡ、SOFA、PRISM、PCIS、PIM5项评分；分析死亡组与存活组各项评分的差异。结果死亡组与存活组入院时APACHEⅡ、SOFA、PCIS、PRISM、PIM这5种重症评分的差异均有统计学意义（13．43±8．70VS．3．48±3．94；78．38±9．33 vs．88．24±6．84；0．1420±0．2147 vs．0．0153±0．0307；5．48±3．42 vs．1．73±1．94；22．02±8．48 vs．12．68±4．88，P均〈0．001）。APACHEⅡ、SOFA、PCIS、PRISM、PIM这5种重症评分的工作特征曲线下面积（95％CI）分别为0．854（0．798，0．910）、0．838（0．778，0．898）、0．881（0．828，0．934）、0．808（0．748，0．869）、0．936（0．913，0．960），PIM的曲线下面积显著高于其他评分。结论5种评分用于评估疾病轻重程度均有效，对评判预后、评估病情严重程度有很好的鉴别能力，尤以PIM更加显著。Objective To investigate the effect of several scoring systems including of acute physiol- ogy and chronic health evaluation Ⅱ （APACHEⅡ ） score, sequential organ failure assessment （SOFA） score, pediatric risk of mortality score（ PRISM）, pediatric critical illness score （PCIS） and paediatric index of mortality（PIM） in estimating the prognosis of illness in pediatric severe cases. To select a more appropriate scoring system for PICU. Methods From January 2013 to December 2014,486 cases admissed in PICU of Shengjing Hospital of China Medical University were enrolled in the study,including 42 hospital death cases （dead group）and 444 survived or cured cases（ survival group）. We estimated each patient with APACHE Ⅱ, SOFA, PCIS, PRISM and PIM on admission and compared the scores between dead group and survival group. Results The results of APACHE Ⅱ, SOFA, PCIS, PRISM, PIM showed significant defferences be- tween dead group and survival group（ 13.43 ± 8.70 vs. 3.48 ± 3.94 ;78.38 ± 9. 33 vs. 88.24 ± 6. 84 ;0. 142 0 ±0. 214 7 vs. 0. 015 3 ±0. 030 7 ;5.48± 3.42 vs. 1.73 ± 1.94 ;22. 02 ±8.48 vs. 12. 68 ±4. 88 ,P 〈 0. 001 ）. Areas under the receiver operating characteristic curves of APACHE Ⅱ , SOFA, PRISM, PCIS and PIM （95% CI） were 0. 854 （ 0. 798,0. 910 ）, 0. 838 （ 0. 778,0. 898 ）, 0. 881 （ 0. 828,0. 934 ）, 0. 808 （ 0. 748, 0. 869） ,0. 936（0. 913,0. 960）. Areas under the receiver operating characteristic curves of PIM was the lar- gest. Conclusion All the 5 kinds of severe scoring systems are effective and have a good ability to asses the prognosis and severity of diseases. It seems that PIM is the most effective.

关 键 词：危重病 危重病评分 预后 儿童 

分 类 号：R720.597[医药卫生—急诊医学]