国内外评价危重患儿病情严重程度评分体系的相关性研究  

A correlation study among scoring systems for assessing the severity of illness in critically ill pediatric patients

作　　者：芦秀兰[1] 张新萍[1] 刘潇[1] 姚震亚[1] 刘萍萍[1] 左超[1] 颜海鹏[1] 仇君[1] 

机构地区：[1]湖南省儿童医院急救中心,长沙410007

出　　处：《中国小儿急救医学》2015年第11期767-770,共4页Chinese Pediatric Emergency Medicine

基　　金：十二五国家科技支撑项目（2012BA104802）;湖南省卫生厅指导项目（C2013-032）;湖南省卫生厅一般项目（B2013-102）

摘　　要：目的分析国外三种评分即儿童死亡风险评分（pediatricriskofmortalityscore，PRISM）、小儿死亡指数评分（pediatricindexofmortality，PIM）和二代小儿死亡指数评分（pediatricindexofmortality2，PIM2）与国内小儿危重病例评分（pediatricclinicalillnessscore，PCIS）在评估重症患儿病情严重程度时是否存在相关性。方法2012年8月1日至2013年5月31日入住PICU的852例重症患儿为研究对象，收集患儿年龄、性别、诊断、结局和4种评分系统的相关生理参数。结果本研究最终纳入852例重症患儿，其中男518例（60．80％），女334例（39．20％），男女比例为1．55：1，月龄的中位数和四分位数间距为6．5（2—21）个月。107例（12．56％）患儿在住院期间或者出院短时间内死亡。重症患儿所患疾病主要以呼吸系统疾病、混合性疾病、血液系统疾病、神经系统疾病和先天性心血管系统疾病为主。利用Pearson相关分析国外三个评分的相关性发现，PRISM与PIM和PIM2呈正相关（r=0．490，P〈0．001；r=0．477，P〈0．001）；PIM与PIM2呈正相关（r=0．938，P〈0．001）。PCIS与PRISM、PIM和PIM2呈负相关，Spearman相关系数分别为－0．208、－0．166和－0．189（P〈0．001）。结论PRISM与PIM、PIM2三个评分之间均呈正相关，PCIS与国外三个评分呈低负相关，提示PCIS评分越低能提示病情危重，但不能充分反映重症患儿疾病的严重程度。Objective To analyse the correlation among pediatric risk of mortality score（ PRISM）, pediatric index of mortality （ PIM）, pediatric index of mortality 2 （ PIM2 ） and pediatric clinical illness score （PCIS）. Methods Eight hundred and fifty-two critically ill children were recruited in the study from lth Jan 2014 to 31 th Jun 2013. Information on age, sex, diagnosis, the outcome and the variables required to calculate PRISM, PIM, PIM2 and PCIS were collected. Results Among 852 critically ill cases enrolled in the study, 518 patients were male and 334 were female,the ratio of male to female was 1.55： 1. The median of age was 6. 5 （IQR：2-21） months. Seven hundred and forty-five patients survived at the end of the PICU stay, the rest died（ 107 patients, 12. 56% ）. The majority of patients were suffering from respiratory diseases, miscellaneous diseases ,hematological system diseases, nervous system diseases and congenital heart diseases. The estimated probabilities of death reveal a positive and significant correlation between the PRISM and the PIM, PIM2, with Pearson＇ s correlation coefficient being 0. 490 （ P 〈 0. 001 ） and 0. 477 （ P 〈 0. 001 ）, respectively. The correlation coefficient between the PIM and PIM2 was 0. 938 （ P 〈 0. 001 ）. The correlation coefficient be- tween the PCIS and PRISM,PIM,PIM2 were -0. 208（P 〈0. 001 ）, -0. 166（P 〈0. 001 ） and -0. 189（P 〈 0. 001 ） ,respectively. Conclusion A positive correlation was found among PRISM,PIM and PIM2 scores. A negative correlation was found between PCIS and other three scores （PRISM, PIM and PIM2 ）. The study has demonstrated that lower PCIS can indicate the severity of illness, but the scoring system of PCIS couldn＇ t fully evaluate the severity of illness for critically ill pediatric patients.

关 键 词：儿童死亡风险评分 小儿死亡指数评分 小儿危重病例评分 相关性分析 

分 类 号：R449[医药卫生—诊断学]