儿童脓毒性休克年龄适应性快速序贯器官衰竭评分模型的建立及价值分析  

Establishment and evaluation of the age-adaptive qSOFA model in pediatric septic shock

作　　者：张丹如[1] 梁亚峰[1] 程健[1] 林凌洁 季林梅[1] 严纯雪[1] ZHANG Dan-Ru;LIANG Ya-Feng;CHENG Jian(Department of Pediatric Intensive Care Unit,The Second Affiliated Hospital&Yuying Children's Hospital,Wenzhou Medical University,Wenzhou,Zhejiang 325027,China)

机构地区：[1]温州医科大学附属第二医院PICU,浙江温州325027

出　　处：《中国妇幼保健》2022年第8期1417-1420,共4页Maternal and Child Health Care of China

基　　金：浙江省医药卫生科技计划项目(2017KY477)。

摘　　要：目的 探讨儿童年龄适应性快速序贯器官衰竭评分(qSOFA)模型建立对脓毒性休克患儿的预警价值。方法 采取回顾分析温州医科大学附属第二医院PICU确诊为脓毒性休克168例患儿,按年龄分为3组:≥1月~1岁组,>1~6岁组,>6~14岁组。回顾统计各年龄组存活患者和死亡患者入科时的临床观察指标数据,建立儿童年龄适应性qSOFA模型并与pSOFA进行严重程度和预警价值对比。结果 儿童年龄适应性qSOFA与儿童序贯器官功能障碍(pSOFA)进行病情严重程度评分对比,死亡组和存活组儿童年龄适应性qSOFAZ值为-6.984, pSOFA的Z值为-7.921,差异均有统计学意义(均P<0.000)。绘制脓毒性休克患儿ROC曲线下面积比较,儿童年龄适应性qSOFA评分的AUC为0.855(P<0.000),约登指数为0.567,最佳截断点1.5,灵敏度(%)为0.817,特异度(%)为0.75。pSOFA评分的AUC为0.864(P<0.000),约登指数为0.619,最佳截断点7.5,灵敏度(%)为0.767,特异度(%)为0.852。当儿童年龄适应性qSOFA≥1分时有发生脓毒性休克的风险,≥2分时有较高的死亡风险。结论 AqSOFA灵敏度和特异性较高,建议可以作为儿童脓毒性休克的预警评估量表,且只有3个变量值,使用更便捷,有助于客观、标准地快速识别出潜在的脓毒性休克患儿。Objective Toexplore the early warning value of the pediatric age-adapted quick sequential organ failure assessment(qSOFA) model in childrenwith septic shock.Methods We performed a retrospective analysis of 168 children diagnosed with septic shock in our PICU of the Second Affiliated Hospital of Wenzhou Medical University.They were taken and divided into three groups according to age: ≥1 month-1 year old group, >1-6 years old group, and >6-14 years old group.The data of clinical observation indicators at the time of admission of surviving and deceased patients in each age group were retrospectively counted, and the AqSOFA was applied to compare the severity and early warning value with pSOFA.Results pediatric age-adapted quick qSOFA was compared with pSOFA for severity scores.pediatric age-adapted quick qSOFA Z-value-6.984 and pSOFA Z-value-7.921 were found in the death and survival groups, with P<0.000 indicating significant differences.The area under the ROC curve of children with septic shock was plotted for comparison.pediatric age-adapted quick qSOFA score AUC(0.855, P<0.000), Yordon index 0.567, best cut-off point 1.5, sensitivity(%) 0.817, specificity(%) 0.75.pSOFA score AUC(0.864, P<0.000), Yordon index 0.619, best cut-off point 7.5,sensitivity(%) 0.767, specificity(%) 0.852.There is a risk of septic shock when the AqSOFA score is ≥1, and a higher risk of death when it is ≥2.Conclusion pediatric age-adapted quick qSOFA can be used as a scale of early warning assessment of children with septic shock, with high sensitivity and specificity.The table has only three variables, allowing a more rapid and objective identification of children with septic shock.

关 键 词：儿童 脓毒性休克 儿童年龄适应性 快速序贯器官衰竭评分 预警 

分 类 号：R720.59[医药卫生—儿科]