四种危重评分法预测新生儿危重症的研究  

Study on Four Illness Severity Score Methods in Predicting Neonatal Critical Illness

作　　者：刘翠[1] 李涛[2] 付宇[3] 曾超[1] 李意[1] 袁满[1] 陈白杨 

机构地区：[1]湖北医药学院临床技能教学培训中心,湖北十堰442000 [2]湖北医药学院附属太和医院,湖北十堰442000 [3]湖北医药学院附属人民医院儿科3病区,湖北十堰442000

出　　处：《湖北医药学院学报》2016年第5期469-472,共4页Journal of Hubei University of Medicine

摘　　要：目的:探讨NCIS、TRIPS、SNAP-Ⅱ和SNAPPE-Ⅱ评分法对新生儿危重症预测的准确性及评估的优越性。方法:收集2015年本院新生儿重症监护室的临床资料进行前瞻性研究,比较4种评分法在对死亡、Ⅲ度颅内出血、中重度HIE、机械通气、败血症、用氧时间>21 d、喂养不耐受>7 d、住院时间>28 d、3次输血治疗等9种新生儿危重症发生率预测的准确性及评估优越性方面的价值。结果:480例新生儿纳入研究。H-L拟合度检验示4种评分模型均有较好的拟合度(P>0.05),P值分别为0.53、0.68、0.92、0.94。分别分析发生9种危重症时,4种评分法的受试者工作特征曲线下面积(AUC)均>0.5;其中对死亡、中重度HIE、机械通气预测的准确性较高,AUC均>0.8。TRIPS和SNAPPE-Ⅱ预测上述3种新生儿危重症的准确性最高。结论:TRIPS和SNAPPE-Ⅱ有较高的新生儿死亡、中重度HIE、机械通气的预测准确性,可以在临床中应用。TRIPS评分简单,可快速取得,可在基层医院推广使用。Objective To explore the accuracy and superiority of NCIS,TRIPS,SNAP-Ⅱ and SNAPPE-Ⅱ in predicting neonatal critical illness. Methods The clinical data of patients in neonatal intensive care unit were collected in our hospital in 2015. The accuracy and superiority of the above 4 scoring methods on predicting the incidences of 9 kinds of neonatal critical illness,including death,degree Ⅲ intracranial hemorrhages,moderate to severe HIE,mechanical ventilation,sepsis,using oxygen time 〉21 d,feeding intolerance 〉7 d,length of stay 〉28 d,undergoing three times of blood transfusion treatment were compared. Results Total 480 neonates were enrolled in this study. H-L fit test showed that the four scoring methodes had good fitting degree（ P〉0.05）,the value of P was 0.53,0.68,0.92,0.94,respectively. Area under the working characteristic curve（ AUC） of the subjects was all 〉 0. 5 by the 4 scoring methods. The accuracy of predicting death,moderate or severe HIE and mechanical ventilation was high,the AUC were all 〉 0. 8. TRIPS and SNAPPE-Ⅱ were the most accurate predictors of these three neonatal critical illnesses. Conclusion The accuracy of TRIPS and SNAPPE-Ⅱ in predicting neonatal mortality,moderate or severe HIE and mechanical ventilation were higher,which could be used in clinical. TRIPS scoring method was simple and quick,which could be use widely in basic hospital.

关 键 词：危重评分法 死亡 中重度HIE 机械通气 TRIPS 

分 类 号：R720.597[医药卫生—急诊医学]