新生儿危重病例评分法的临床应用  

Clinical application of neonatal critical illness score

作　　者：何柳[1] 夏斌[2] 虎春元 李淑萍[1] 周娟[1] 严琼珍 

机构地区：[1]四川省巴中市中心医院新生儿科,636000 [2]四川大学华西第二医院新生儿科、出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《中华妇幼临床医学杂志（电子版）》2017年第2期162-168,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家自然科学基金资助项目(81370738)~~

摘　　要：目的探讨《新生儿危重病例评分法(NCIS)(草案)》对临床危重新生儿救治的指导意义。方法选取2012年5月至2015年5月,于巴中市中心医院新生儿科收治的满足《NCIS(草案)》中,新生儿危重病例诊断标准的581例危重新生儿为研究对象。采用回顾性分析方法,收集这581例危重新生儿的临床资料,对单项指标符合《NCIS(草案)》新生儿危重病例诊断标准,以及NCIS评分≤90分的危重新生儿的NCIS检查项目扣分情况,进行统计学分析。根据581例危重新生儿的预后情况,将其分为预后良好组(n=445)及预后不良组(n=136)。对预后良好组及预后不良组危重新生儿的临床资料进行统计学分析。结合已有研究结果及临床经验,选取相应因素进行危重新生儿预后独立影响因素的多因素非条件logistic回归分析。结果 (1)本研究581危重新生儿中,男性多于女性(370∶211);发病日龄以出生1d内为主(72.3%,420/581);剖宫产分娩患儿多于经阴道分娩患儿(337∶244);54.7%(318/581)患儿合并至少一项高危因素;新生儿危重疾病构成中,前3位依次为新生儿呼吸窘迫综合征(NRDS)(32.4%,188/581),新生儿肺炎(22.7%,132/581),新生儿窒息(15.8%,92/581)。(2)这581危重新生儿中,因单项指标符合《NCIS(草案)》新生儿危重病例诊断标准,而被纳入危重新生儿者,共计455例(78.3%)。其中,以需进行气管插管辅助机械通气治疗或反复呼吸暂停对刺激无反应者、有换血指征的高胆红素血症者、低血糖者最为常见,所占比例分别为59.3%(270/455)、16.7%(76/455)及10.1%(46/455)。这581危重新生儿中,因NCIS评分≤90分符合《NCIS(草案)》新生儿危重病例诊断标准,而被纳入危重新生儿者,共计558例(96.0%)。其NCIS检查项目中,扣分最多的项目前3位依次为pH值≤7.25或≥7.50(31.5%,176/558),呼吸频率≤25次/min或≥60次/min(18.1%,101/558),动脉血氧分压(Pa_(O_2))≤60 mmHg(1 mmHg=0.133kPa)(16.8%,94/558)。ObjectiveTo investigate the significance of neonatal critical illness score （NCIS）（Draft） for treating critically ill neonates. MethodsA total of 581 cases of critically ill neonates who were treated in Department of Neonatology, Bazhong Central Hospital of Sichuan Province from May 2012 to May 2015 were selected as research subjects. All the 581 cases met the neonatal critical cases diagnostic criteria in NCIS （Draft） and their clinical data were collected by retrospective method. The single index that matched the index of critically ill neonates of NCIS （Draft） and the score points of inspection items of NCIS for critically ill neonates whose NCIS score ≤90 points were statistically analyzed. According to the prognosis of the 581 cases, they were enrolled into good prognosis group （n=445）, and poor prognosis group （n=136）. The clinical data between two groups were statistically analyzed. Combined with the results of existing researches and clinical practice, some factors were introduced into multivariate unconditional logistic regression analysis to analyzed the prognostic factors of critically ill neonates. Results①Among the 581 cases of critically ill neonates, the number of male neonates was higher than female neonates （370∶211）. Most neonates were born in 1 d （420 cases, 72.3%）, and there were more neonates via cesarean section than those via vaginal delivery （337∶244）. And 54.7% （318/581） neonates had at least one high risk factor. The first three diseases of critically ill neonates were neonatal respiratory distress syndrome （NRDS） （32.4%, 188/581）, neonatal pneumonia （22.7%, 132/581）, and neonatal asphyxia （15.8%, 92/581）. ②Among the 581 cases of critically ill neonates, 455 cases （78.3%） were diagnosed as neonatal critical cases by single index of NCIS （Draft）, which were mostly presented as requiring tracheal intubation or repeating apnea without response to stimulation （59.3%, 270/455）, severe hyper bilirubinemia （16

关 键 词：危重病 新生儿危重病例评分法 预后 临床应用 婴儿 新生 

分 类 号：R720.597[医药卫生—急诊医学]