儿童早期预警评分在急性淋巴细胞白血病患儿中的应用  

The warning function of PEWS on septic shock of children with acute lymphoblastic leukemia after chemotherapy

作　　者：唐慧[1] 杨艳[1] 李映兰[2] 李爱连[1] 贺茜[1] 彭伶丽[3] 

机构地区：[1]中南大学湘雅医院儿科门急诊,长沙市410008 [2]中南大学湘雅医院护理部,长沙市410008 [3]中南大学湘雅医院骨科,长沙市410008

出　　处：《中华护理杂志》2017年第12期1422-1426,共5页Chinese Journal of Nursing

基　　金：中华护理学会立项科研课题(ZHKY201606)

摘　　要：目的探讨将儿童早期预警评分(Pediatric Early Warning Score,PEWS)应用于急性淋巴细胞白血病化疗患儿发生感染性休克的早期预警。方法对长沙市某三级甲等医院2015年1月—2016年5月住院的57例急性淋巴细胞白血病化疗后中性粒细胞缺乏合并感染患儿进行回顾性研究,根据患儿生命体征监测值进行PEWS评分,构建ROC曲线,得出预警患儿发生感染性休克的PEWS截断点,将PEWS评分应用于2016年10月—2017年3月急性淋巴细胞白血病化疗后中性粒细胞缺乏合并感染患儿的早期评估,并根据不同PEWS评分值给予相应的监护级别、吸氧及液体复苏等干预措施;比较两组的休克发生率、病死率及休克转归时间。结果 PEWS评分3.5分为预测急性淋巴细胞白血病化疗患儿发生感染性休克的最佳截断点,根据PEWS评分干预后患儿感染性休克发生率、病死率及休克转归时间均低于干预前(P<0.05)。结论 PEWS可用于对急性淋巴细胞白血病化疗后中性粒细胞缺乏合并感染患儿发生感染性休克进行早期预警,为此类患儿得到及时治疗、改善疾病转归赢得时间。Objective To explore the application and effects of pediatric early warning score （PEWS） on the early warning and identification of septic shock in acute lymphoblastic leukemia children with neutropenia and coinfection at bone marrow suppression period after chemotherapy. Methods A retrospective study of 57 acute lymphoblastic leukemia children with neutropenia and coinfeetion in a tertiary hospital in Changsha from January 2015 to May 2016 was conducted. PEWS was performed based on vital sign monitoring of children. ROC curve was established to evaluate the PEWS warning value when the sick children had septic shock. The obtained PEWS system was applied in the early warning of acute lymphoblastic leukemia children with neutropenia and coiufection from October 2016 to March 2017,and relative intervention measures including setting corresponding monitor level, oxygen uptake and fluid resuscitation were provided according to various PEWS warning value. The incidence of shock ,death rate and the time of recovery between two groups before and after intervention were compared. Results The optimal cut off point of PEWS when children with neutropenia and coinfection had septic shock was 3.5. After intervention,the incidence of shock,death rate and the time of recoveiy were lower than those before intervention （P〈0.05）. Conclusion PEWS can provide effective early warnings for acute lymphoblastie leukemia children with ueutropenia and coinfection. It is beneficial ior disease recovery and subsequent chemotherapy of the patients.

关 键 词：儿童早期预警评分 急性淋巴细胞白血病 粒细胞缺乏 感染 休克 

分 类 号：R473.73[医药卫生—护理学]