影响超低出生体质量儿住院期间死亡风险评估的相关因素分析  

Analysis of Related Factors Affecting the Risk Assessment of Death during Hospitalization of Extremely Low Birth Weight Infants

作　　者：王茜 戎惠[1] 孙瑶 傅彬 沈飞 杨洋[1] 季汝凤 WANG Qian;RONG Hui;SUN Yao;FU Bin;SHENG Fei;YANG Yang;JI Ru-feng(Department of Neonatology,Children's Hospital Affiliated to Nanjing Medical University,Nanjing 210008,China;Department of Pediatrics,Lishui Branch,Affiliated Central University Hospital,Southeast University,Nanjing 211200,China)

机构地区：[1]南京医科大学附属儿童医院新生儿科,江苏南京210008 [2]东南大学附属中大医院溧水分院儿科,江苏南京211200

出　　处：《中山大学学报（医学科学版）》2023年第6期1060-1067,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：南京市卫生科技发展专项(YKK20127)。

摘　　要：【目的】探究影响不同新生儿危重评分对超低出生体质量儿(ELBWI)死亡风险准确预测的相关因素。【方法】自2019年1月1日至2021年1月1日南京医科大学附属儿童医院和东南大学附属中大医院溧水分院新生儿科收治的ELBWI 186例,经纳入和排除标准筛选后最终纳入125名ELBWI。其中死亡组47例、存活组78例。收集围生期一般资料以及新生儿急性生理学评分-Ⅱ(SNAP-Ⅱ)、新生儿急性生理学评分围生期补充-Ⅱ(SNAPPE-Ⅱ)、新生儿临床危险指数(CRIB)、新生儿临床危险指数-Ⅱ(CRIB-Ⅱ)以及国内开发的新生儿危重病例评分(NCIS)其包含的所有评分条目内容进行单变量、多变量统计,并绘制列线图及受试者工作曲线(ROC)进行分析。【结果】生后收缩压、最大吸入氧浓度、BE值和出生体质量是影响ELBWI死亡风险准确评估的重要因素[收缩压OR值0.968,95%CI:0.938-0.999,P=0.043;最大吸入氧浓度OR值1.020,95%CI:1.006-1.034,P=0.006;BE的OR值0.868,95%CI:0.786-0.959,P=0.005;出生体质量OR值0.994,95%CI:0.991-0.997,P=0.000],ROC示以上四者的综合曲线下面积0.71、95%可信区间0.610-0.799,优于CRIB评分。【结论】较低收缩压、较高吸入氧浓度、较大BE值、较小出生体质量为影响ELBWI死亡风险准确评估的关键因素。在新评分的开发中,推荐将以上四者纳入评估条目可得到效率更优的ELBWI危重评分预测体系。【Objective】To explore the influencing factors of different scores on predicting death risk of extremely low birth weight infants(ELBWI).【Methods】A total of 186 cases of ELBWI admitted by the Children's Hospital affiliated to Nanjing Medical University and the Lishui Branch of the Affiliated Zhongda Hospital of Southeast University were admitted from January 1,2019 to January 1,2021,and 125 ELBWIs were finally included after screening by inclusion and exclu‐sion criteria.There were 47 cases in the death group and 78 cases in the survival group.General data and the items of score for neonatal acute physiology versionⅡ(SNAP-Ⅱ),simplified version of the score for neonatal acute physiology perina‐tal extension(SNAPPE-Ⅱ),clinical risk index for babies(CRIB),clinical risk index for babiesⅡ(CRIB-Ⅱ)and the national critical illness score(NCIS)were collected.Univariate and multivariate analysis was performed and nomogram was evaluated using receiver operating characteristic curve(ROC).【Results】It was found that systolic blood pressure,maximum inhaled oxygen concentration,BE value and birth weight were important factors in ELBWI mortality risk assess‐ment[systolic blood pressure OR:0.968,95%CI:0.938-0.999,P=0.043;maximum inhaled oxygen concentration OR:1.020,95%CI:1.006-1.034,P=0.006;BE OR:0.868,95%CI:0.786-0.959,P=0.005;birth weight OR:0.994,95%CI:0.991-0.997,P=0.000].ROC showed that the area under the curve of the above four variables is 0.71,and the 95%confidence interval is 0.610-0.799,which is better than CRIB score.【Conclusion】Lower systolic blood pressure,higher inhaled oxygen concentration,higher BE and lower birthweight are important influencing factors to predict the death risk of ELBWI.The above four items should be included in the newly developed score assessment to obtain a more effective ELBWI prediction system.

关 键 词：危重疾病评分 超低出生体质量儿 死亡 影响因素 预测 

分 类 号：R735[医药卫生—肿瘤]