儿童早期预警评分在中性粒细胞缺乏白血病患者发生感染性休克中的应用效果  

Clinical application of the pediatric early warning score in septic shock of leukemia children with neutrophil deficiency

作　　者：刘洋[1] 马琳玉[1] 申雪兰 张崇敏[1] 张力 唐晓敏 Liu Yang;Ma Linyu;Shen Xuelan;Zhang Chongmin;Zhang Li;Tang Xiaomin(Hematology Oncology Ward of Children’s Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,Children’s Hospital of Chongqing Medical University,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics)

机构地区：[1]重庆医科大学附属儿童医院血液肿瘤科一病房、儿童发育疾病研究教育部重点实验室、儿童发育重大疾病国家国际科技合作基地、儿科学重庆市重点实验室,重庆400014

出　　处：《重庆医科大学学报》2020年第2期278-282,共5页Journal of Chongqing Medical University

基　　金：2013-2014年度国家临床重点专科建设资助项目(编号:国卫办医涵〔2013〕544号);重庆市卫计委科研资助项目(编号:2017MSXM043)。

摘　　要：目的:探讨儿童早期预警评分在中性粒细胞缺乏白血病患者发生感染性休克中的临床应用效果。方法:将重庆医科大学附属儿童医院2016年1月至2016年12月住院的67例白血病化疗后中性粒细胞缺乏合并感染患者作为回顾观察组,对其临床资料进行回顾性研究,根据患者监测值进行早期预警评分,构建ROC曲线,得出该组患者发生感染性休克的早期预警截断点,以2017年1月至2017年12月白血病化疗后中性粒细胞缺乏合并感染的72例患者作为前瞻研究组,将早期预警评分应用于研究组患者的早期评估,根据不同早期预警评分值实施相应的抗感染治疗、给氧、液体复苏、血管活性药物、成分输血、应用重组活化蛋白C等干预措施;比较2组患者感染性休克的发生率及休克致死亡率。结果:早期预警评分3.5分为预测中性粒细胞缺乏白血病患者发生感染性休克的最佳截断点,在该截断点,PEWS对感染性休克预测的灵敏度为83.3%,特异度为83.7%;研究组感染性休克发生率及病死率明显低于观察组(P<0.01)。结论:早期预警评分能帮助护理人员对病情进行有效评估,根据早期预警评分,帮助其早期识别中性粒细胞缺乏白血病患者感染性休克的征象,同时在最佳截断点及时采取针对性的治疗、护理干预,有效改善疾病的预后。Objective:To investigate the clinical application of the pediatric early warning score(PEWS) in septic shock of leukemia children with neutrophil deficiency. Methods:A total of 67 leukemia patients who suffered from neutrophil deficiency and complicated infection after chemotherapy in Children’s Hospital of Chongqing Medical University from January to December,2016 were included in the study as retrospective observation group. A retrospective study was performed on their clinical data. The PEWS was determined based on their monitoring data to establish the receiver operating characteristic curve and obtain the optimal cut-off value of PEWS for septic shock. A total of 72 leukemia patients who suffered from neutrophil deficiency and complicated infection after chemotherapy from January to December,2017 were included in the study as prospective study group. The PEWS was used for the early evaluation of the patients in the prospective study group. According to different PEWS values,the patients were given corresponding intervention measures,including anti-infective therapy,oxygen therapy,fluid resuscitation,vasoactive agent,component transfusion,and recombinant activated protein C. The incidence rate of septic shock and the mortality rate due to septic shock were compared between the two groups. Results:The PEWS value of 3.5 was the optimal cut-off value for predicting septic shock in leukemia children with neutrophil deficiency,with a sensitivity of 83.3% and a specificity of 83.7%. The prospective study group had significantly lower incidence rate of septic shock and mortality rate due to septic shock than the retrospective observation group(P<0.01). Conclusion:PEWS can be used for effective evaluation of condition and early identification of signs of septic shock in leukemia children with neutrophil deficiency. Accordingly,taking specific treatments and nursing interventions at the appropriate time will improve the prognosis of the disease.

关 键 词：儿童早期预警评分 白血病 粒细胞缺乏 感染性休克 

分 类 号：R735.7[医药卫生—肿瘤]