NICU早发型新生儿败血症发病预测模型建立  

Establishment of prediction model of early-onset neonatal sepsis in NICU

作　　者：冀敏[1] 刘杰[1] 李焕 朱彩霞 杜鹃 JI Min;LIU Jie;LI Huan;ZHU Cai-xia;DU Juan(Anyang Maternal and Child Health Hospital,Anyang,Henan 450000,China)

机构地区：[1]安阳市妇幼保健院儿科,河南安阳455000

出　　处：《中华医院感染学杂志》2022年第21期3317-3320,共4页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划基金资助项目(LHGJ20200895)。

摘　　要：目的通过建立新生儿重症监护病房(NICU)早发型新生儿败血症发病预测模型,为临床中尽早干预提供指导。方法选择2018年6月-2021年6月安阳市妇幼保健院新生儿科发生新生儿败血症63例纳入败血症组。按照1∶2比例随机纳入医院出生足月健康新生儿126名为健康组。通过电子病历系统回顾性收集其临床资料和实验室检查结果,采用受试者工作特征(ROC)曲线分析本预测模型与新生儿败血症风险计算器(SRC)对新生儿败血症的评估效能,并分析其评估结果相符程度。结果多因素Logistic回归分析结果显示早产、母亲绒毛膜羊膜炎、出生时Apgar评分均为新生儿早发型败血症的危险因素(P<0.05);ROC分析结果显示预测模型、败血症计算器对新生儿败血症诊断曲线下面积分别为0.925、0.906,当二者联合时诊断曲线下面积为0.941,均具有统计学意义(P<0.05);预测模型中在SRC计算器评估为“败血症表现”(n=55)、“疑似临床”(n=19)以及“正常”(n=115)三个等级下预测模型平均得分分别为(11.83±1.86)、(8.76±1.58)、(4.55±1.09)分,比较差异具有统计学意义(P<0.05)。结论以实验室血液学指标所建立的预测模型在新生儿早发型败血症评估中有较好的应用价值,联合SRC可提高对新生儿早发型败血症的评估效能。OBJECTIVE To establish the prediction model of early-onset neonatal sepsis in neonatal intensive care unit(NICU)so as to take intervention measures as early as possible.METHODS A total of 63 neonates who had sepsis and were treated in neonatology department of Anyang Maternal and Child Health Hospital from Jun 2018 to Jun 2021 were assigned as the sepsis group,and 126 full-term and healthy neonates were randomly chosen in a 1∶2 ratio and set as the healthy group.The clinical data and results of laboratory test were retrospectively collected by electronic medical record system,the efficiencies of the prediction model and sepsis risk calculator(SRC)in assessment of neonatal sepsis were analyzed by receiver operating characteristic(ROC)curve,and the correspondence between the assessment results was observed.RESULTS The result of multivariate logistic regression analysis showed that premature delivery,maternal chorioamnionitis and Apgar score at birth were the risk factors for the early-onset neonatal sepsis(P<0.05).ROC curve analysis indicated that the areas under curves of the prediction model and the SRC were respectively 0.925 and 0.906 in diagnosis of neonatal sepsis,the area under curve of the combination of the two tools was 0.941,and there was significant difference(P<0.05).The average scores of the prediction models under the three grades’sepsis manifestation’(n=55),’suspected clinical’(n=19)and’normal’(n=115)that were assessed by SRC were(11.83±1.86)points,(8.76±1.58)points and(4.55±1.09)points,respectively,and there was significant difference(P<0.05).CONCLUSION The prediction model that is established based on laboratory hematological indexes has significant value in assessment of early-onset neonatal sepsis,and its combination with SRC may improve the efficiency in assessment of the early-onset neonatal sepsis.

关 键 词：新生儿重症监护病房 早发型新生儿败血症 预测模型 新生儿败血症风险计算器 受试者工作特征曲线 

分 类 号：R722.13[医药卫生—儿科]