三种评分系统预测新生儿呼吸窘迫综合征死亡风险的效能比较  

Prediction of mortality in neonates with neonatal respiratory distress syndrome using three scoring systems

作　　者：陈锶 黄为民[1] CHEN Si;HUANG Weimin(Department of Neonatology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,Guangdong Province,China)

机构地区：[1]南方医科大学附属南方医院新生儿科,广东广州510515

出　　处：《解放军医学院学报》2020年第10期983-987,共5页Academic Journal of Chinese PLA Medical School

摘　　要：目的比较新生儿危重病例评分(Neonatal Critical Illnesss Score,NCIS)、新生儿急性生理学评分-Ⅱ(Score for Neonatal Acute Physiology-Ⅱ,SNAP-Ⅱ)以及新生儿急性生理学评分-Ⅱ及围生期补充(Score for Neonatal Acute Physiology-Ⅱand Perinatal Extension,SNAPPE-Ⅱ)预测新生儿呼吸窘迫综合征死亡风险的效能。方法选择2017年1月-2018年6月南方医科大学附属南方医院新生儿科收治的237例诊断为新生儿呼吸窘迫综合征的患儿,根据出院时的结局将其分为生存组和死亡组。所有患儿进行NCIS、SNAP-Ⅱ以及SNAPPE-Ⅱ评分,分别绘制这三种评分预测患儿死亡风险的ROC曲线,并比较其AUC值。结果NCIS、SNAP-Ⅱ和SNAPPE-Ⅱ预测新生儿呼吸窘迫综合征死亡风险的AUC值分别为0.859(95%CI:0.808~0.901)、0.767(95%CI:0.708~0.819)和0.798(95%CI:0.741~0.847),三者比较差异无统计学意义(P>0.05)。SNAP-Ⅱ和SNAPPE-Ⅱ预测死亡的最佳界值分别为9.5分(敏感度72.22%,特异性77.63%)和19.5分(敏感度83.33%,特异性66.21%)。NCIS评分中非危重儿组、危重儿组和极危重儿组的病死率分别为0、8.43%和66.67%,差异有统计学意义(P<0.05)。符合NCIS单项指标或分值指标的危重儿病死率分别为0和3.4%,明显低于同时符合NCIS单项指标和分值指标的危重儿病死率14.8%(P<0.05)。结论NCIS、SNAP-Ⅱ和SNAPPE-Ⅱ预测新生儿呼吸窘迫综合征死亡风险的效能一致。NCIS对于疾病危重程度分组恰当,且单项指标联合分值指标预测疾病危重度更有意义。Objective To compare the ability of Neonatal Critical Illnesss Score(NCIS),Score for Neonatal Acute Physiology-Ⅱ(SNAP-Ⅱ)and Score for Neonatal Acute Physiology-Ⅱand Perinatal Extension(SNAPPE-Ⅱ)in predicting the mortality of neonates with neonatal respiratory distress syndrome(NRDS).Methods From January 2017 to June 2018,237 neonates diagnosed with NRDS and admitted to the NICU of the Southern Hospital were selected and they were divided into survival group and death group according to their outcome at the time of discharge.All neonates were evaluated with NCIS,SNAP-Ⅱand SNAPPE-Ⅱ,and the ROC curves of the three scoring systems for predicting the mortality were described,then their AUC values were compared.Results The AUC values of NCIS,SNAP-Ⅱand SNAPPE-Ⅱwere 0.859(95%CI:0.808-0.901),0.767(95%CI:0.708-0.819)and 0.798(95%CI:0.741-0.847),without statistically significant difference(P>0.05).The cut-offs of SNAP-Ⅱand SNAPPE-Ⅱwere 9.5(sensitivity 72.22%,specificity 77.63%)and 19.5(sensitivity 83.33%,specificity 66.21%).The mortality of non-critical group,critical group and extremely critical group by NCIS were 0,8.43%and 66.67%,with statistically significant differences(P<0.05).The mortality of critical neonates met the NCIS individual index or score index was 0 and 3.4%,which was significantly lower than that of neonates both met individual index and score index by 14.8%(P<0.05).Conclusion The ability of NCIS,SNAP-Ⅱand SNAPPE-Ⅱto predict the mortality of the neonates with NRDS is consistent.NCIS is appropriate for the classification of disease severity,and the combination of individual index and score index is more significant in predicting severity.

关 键 词：新生儿 死亡风险 新生儿危重病例评分 新生儿急性生理学评分-Ⅱ 新生儿急性生理学评分-Ⅱ及围生期补充 

分 类 号：R722[医药卫生—儿科]