2种危重症评分在手足口病并脑炎病情评估中的应用研究  

Application of two critical illness scores in assessment of hand-foot-mouth disease combined with encephalitis

作　　者：周永海[1] 陈伊莉[1] 夏芳琴[2] 留佩宁[1] 

机构地区：[1]温州医科大学附属第二医院育英儿童医院儿童保健科,浙江温州325027 [2]温州医科大学附属第二医院育英儿童医院新生儿科

出　　处：《中华全科医学》2016年第3期428-430,共3页Chinese Journal of General Practice

摘　　要：目的探讨小儿危重病例评分（PCIS）及第三代小儿死亡危险评分（PRISMⅢ）在儿童手足口病并脑炎病情评估及预后判断中的应用价值。方法分别用PCIS及PRISMⅢ对2010年收住院的手足口病并脑炎患儿进行评分,分非危重组、危重组和极危重组,比较各组间的死亡率,运用ROC曲线比较两者在预判手足口病并脑炎患儿死亡风险的特异性和灵敏度。结果 ①PCIS评分：3组死亡率比较差异有统计学意义（8/466,10/12,5/5,χ^2=93.099,P〈0.001）;②PRISMⅢ评分：3组比较死亡率,差异亦有统计学意义（4/458,4/7,15/18,χ^2=114.579,P〈0.001）;③2种评分的非危重组、危重组和极危重组组间死亡率比较,差异均无统计学意义（1.72%vs.0.87%,χ^2=1.282,P=0.258,88.24%vs.76.00%,χ^2=0.349,P=0.555）;④Logistic回归分析显示：PCIS各评分指标中,心率、血压（收缩压）及肾功能,PRISMⅢ各评分指标中,神志状态及血糖对手足口病死亡风险预测作用较强（P均〈0.05）。⑤ROC曲线下面积分别为：PCIS评分0.929,PRISMⅢ评分0.985。结论 PCIS和PRISMⅢ均可用于手足口病并脑炎患儿病情的评估,两者在预测其死亡风险方面有较高的特异性和灵敏度。Objective To investigate the advantages ofpediatric critical illness score（ PCIS） and the pediatric risk of mortalityⅢ（ PRISM Ⅲ） in the judgment of the severe extent and prognosis in children with hand-foot-mouth disease and encephalitis. Methods PCIS and PRISM Ⅲ were sued to assess the severity of children with hand-foot-mouth disease and encephalitis. The patients were divided into three groups（ very critical,critical,noncritical group） according to the scores.The mortality was calculated and compared among the three groups. The specificity and sensitivity of PCIS and PRISM Ⅲin the judgment of the death risk in children hand-foot-mouth disease combined with encephalitis were compared through measuring the area under the ROC curve（ AUC）. Results （1）PCIS score： To compare the mortality of the groups of noncritical,critical and very critical subgroups,the difference was statistically significant（ 8 /466,10 /12,5 /5,χ^2= 93. 099,P〈0. 001）. （2）PRISM Ⅲ score： To compare the mortality of the corresponding groups,the difference was statistically significant（ 4 /458,4 /7,15 /18,χ^2= 114. 579,P〈0. 001）. （3）The comparison between PCIS and PRISMⅢ score： the differences were not statistically significant in mortality between the two groups of non-critical,critical and critical subgroups,respectively（ 1. 72% vs. 0. 87%,χ^2= 1. 282,P = 0. 258,88. 24% vs. 76. 00%,χ^2= 0. 349,P = 0. 555）. （4）Multiple logistic regression analysis revealed heart rate,blood pressure（ systolic blood pressure） and renalfunction of PCIS sore and the state of consciousness and bloodglucose of PRISM Ⅲ score had more effective prediction of the death risk（ P〈0. 05,respectively）. （5）The area under the ROC curve（ AUC） for PCIS and PRISMⅢ were 0. 929 and 0. 985,respectively. Conclusion PCIS and PRISM Ⅲ score,with high specificity and sensitivity,can be used in the judgment of the severe extent and prognosis of children with hand-foot-mouth disease and encephalitis

关 键 词：手足口病 脑炎 小儿危重病例评分 第三代小儿死亡危险评分 死亡率 

分 类 号：R512.5[医药卫生—内科学] R729[医药卫生—临床医学]