学龄前急性上呼吸道感染高热惊厥患儿早期高危病情预测模型的建立  

Establishment of early high-risk disease prediction model for preschool children with acute upper respiratory tract infection and febrile convulsion

作　　者：贺万香[1] 刘小娟 刘颖[1] 梁迎盈[1] HE Wanxiang;LIU Xiaojuan;LIU Ying;LIANG Yingying(Department of Neonatology,Shenzhen Hospital of Peking University,Shenzhen,Guangdong,518036)

机构地区：[1]北京大学深圳医院新生儿科,广东深圳518036

出　　处：《实用临床医药杂志》2023年第12期105-111,117,共8页Journal of Clinical Medicine in Practice

基　　金：广东省医学会医护科研指令性课题资助项目(GDYXH2019ZL028)。

摘　　要：目的 分析学龄前急性上呼吸道感染高热惊厥患儿早期病情变化的影响因素,建立其高危病情的预测模型。方法 采取便利抽样的方法选取2019年1月—2021年6月本院儿科收治学龄前急性上呼吸道感染高热后发生惊厥的患儿384例为研究对象,基于儿童早期预警评分系统(PEWS)将患儿分为低危组294例、中危组65例和高危组25例。采用单因素比较和多元有序Logistic回归分析确定学龄前急性上呼吸道感染高热惊厥患儿早期病情变化的影响因素;采用二元Logistic回归分析确定学龄前急性上呼吸道感染高热惊厥患儿早期病情高危的影响因素;采用受试者工作特征(ROC)曲线分析早期病情高危影响因素的预测效能。基于二元Logistic回归结果绘制高危病情变化列线图。结果 多元有序Logistic回归分析结果发现,年龄、伴有抽搐、伴有呼吸节律紊乱、伴有意识模糊、呼吸频率(BR)、中性粒细胞与淋巴细胞的比值(NLR)、红细胞分布宽度(RDW)、首次惊厥后平均体温均是学龄前急性上呼吸道感染高热惊厥患儿早期病情变化的影响因素(P<0.05)。二元Logistic回归分析结果发现,年龄(>5岁)、伴有抽搐、伴有呼吸节律紊乱、伴有意识模糊、BR、NLR、RDW、首次惊厥后平均体温高(>40.0~41.0℃和>39.0~40.0℃)均是学龄前急性上呼吸道感染高热惊厥患儿早期病情的高危影响因素(P<0.05)。ROC曲线显示,年龄(>5岁)、伴有抽搐、伴有呼吸节律紊乱、伴有意识模糊、BR、RDW、NLR和首次惊厥后平均体温高对高热惊厥患儿早期高危病情预测效能较好(P<0.05)。列线图分析显示,学龄前急性上呼吸道感染高热惊厥患儿高危病情预测模型预测得分为85~287分,可有效评估0.1%~95.0%的风险概率。结论 学龄前急性上呼吸道感染高热惊厥患儿早期病情变化可能受到伴有抽搐、伴有呼吸节律紊乱、伴有意识模糊、BR、NLR、RDW、首次惊厥后�Objective To analyze the influencing factors of early condition changes in preschool children with acute upper respiratory tract infection and febrile convulsion,and to establish a high-risk disease prediction model.Methods A total of 384 preschool children with convulsion after high fever of acute upper respiratory tract infection in our hospital from January 2019 to June 2021 were selected as research objects.Based on the early warning scoring system(PEWS),the children were divided into low-risk group(n=294),medium-risk group(n=65)and high-risk group(n=25).Univariate comparison and multiple ordered Logistic regression analysis were used to determine the influencing factors of early condition of preschool children with acute upper respiratory tract infection and febrile convulsion,binary Logistic regression analysis was used to determine the high-risk influencing factors of early condition of preschool children with acute upper respiratory tract infection and febrile convulsion;ROC curve was used to analyze the prediction efficiency of high-risk influencing factors of early condition.The nomogram of high-risk disease changes was drawn based on the results of binary Logsitic regression.Results[CM]Multiple ordered Logistic regression analysis showed that age[CM],convulsions,disordered respiratory rhythm,blurred consciousness,Br,NLR,RDW and average body temperature after the first convulsion were the influencing factors of the changes of early conditions of preschool children with febrile convulsion caused by acute upper respiratory tract infection(P<0.05).Binary Logistic regression analysis showed that age over five years old,convulsion,respiratory rhythm disorder,confusion of consciousness,Br,NLR,RDW and average body temperature(>40.0 to 41.0℃and>39.0 to 40.0℃)after the first convulsion were the high-risk factors of early condition in preschool children with acute upper respiratory tract infection and febrile convulsion(P<0.05).ROC curve analysis showed that age(>5 yeas old),convulsion,respiratory rhythm diso

关 键 词：学龄前 急性上呼吸道感染 高热惊厥 早期病情 高危病情 病情恶化 

分 类 号：R725[医药卫生—儿科] R179[医药卫生—临床医学]