血管活性正性肌力药物评分在新生儿早发型败血症结局评估中的价值  

The value of vasoactive inotropic score in assessing neonatal early-onset sepsis outcomes

作　　者：张霞[1] 崔铭玲 杨祖铭[1] 冯宗太[1,2] Zhang Xia;Cui Mingling;Yang Zuming;Feng Zongtai(Department of Neonatology,the Affiliated Suzhou Hospital of Nanjing Medical University(Suzhou Municipal Hospital),Suzhou 215002,China;Gusu School,Nanjing Medical University,Suzhou 215002,China)

机构地区：[1]南京医科大学附属苏州医院(苏州市立医院)新生儿科,苏州215002 [2]南京医科大学姑苏学院,苏州215002

出　　处：《中华围产医学杂志》2025年第4期320-325,共6页Chinese Journal of Perinatal Medicine

基　　金：江苏省医学会科研专项资金(SYH-32034-0080(20230027));南京医科大学姑苏学院项目(GSKY20230201)。

摘　　要：目的探讨血管活性正性肌力药物评分(vasoactive inotropic score,VIS)在新生儿早发型败血症(early-onset sepsis,EOS)不良结局评估中的价值。方法回顾性收集2020年1月至2024年3月在南京医科大学附属苏州医院住院的110例EOS患儿,根据结局分为存活组(n=88)和死亡组(n=22)。采用t检验、Mann-Whitney U检验、χ^(2)检验比较2组患儿围产期因素、并发症等情况,采用logistic回归分析影响EOS死亡的危险因素以及受试者工作特征(receiver operating characteristics,ROC)曲线分析VIS对EOS死亡的评估价值。结果死亡组出生胎龄和体重均小于存活组[分别为29.4(26.8~35.3)周与32.8(30.1~37.2)周、1050.0(737.5~2162.5)g与1700.0(1212.5~2587.5)g,Z值分别为-2.16和-2.30,P值均<0.05]。与存活组相比,死亡组窒息[45.5%(10/22)与21.6%(19/88)]、低体温[27.3%(6/22)与8.0%(7/88)]、机械通气[100.0%(22/22)与54.5%(48/88)]、弥散性血管内凝血[22.7%(5/22)与3.4%(3/88)]、新生儿持续肺动脉高压[36.4%(8/22)与11.4%(10/88)]、肺出血[40.9%(9/22)与8.0%(7/88)]的比例较高(χ^(2)值分别为5.16、4.59、15.71、7.09、6.32及12.84,P值均<0.05)。死亡组入院后24 h VIS值和48 h VIS值均高于存活组[分别为15.0(10.0~18.1)与10.0(7.5~10.0)、18.8(12.8~30.0)与10.0(7.5~10.0),Z值分别为-4.60和-4.94,P值均<0.05]。Logistic回归分析显示,入院后24 h VIS值(OR=1.163,95%CI:1.018~1.328)、48 h VIS值(OR=1.114,95%CI:1.031~1.204)、出生窒息(OR=3.815,95%CI:1.017~14.310)、肺出血(OR=4.470,95%CI:1.174~17.017)是死亡的独立危险因素(P值均<0.05)。ROC曲线分析显示,入院后24 h VIS界值为11,曲线下面积为0.807,约登指数0.466,灵敏度为68.2%,特异度为78.4%;入院后48 h VIS界值为12.5,曲线下面积为0.851,约登指数为0.659,灵敏度为95.5%,特异度为70.5%。结论EOS患儿结局与VIS值相关,当48 h VIS值超过12.5时死亡风险高。Objective To investigate the value of vasoactive inotropic score(VIS)in assessing adverse outcomes in neonates with early-onset sepsis(EOS).Methods A retrospective study was conducted on 110 neonates with EOS admitted to the Affiliated Suzhou Hospital of Nanjing Medical University from January 2020 to March 2024.The patients were divided into a survival group(n=88)and a death group(n=22).Perinatal factor,and complications were compared between the two groups using t test,Mann-Whitney U test,and Chi-square test.Logistic regression analysis was used to identify the risk factors for death in patients with EOS,and receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of VIS for death in EOS patients.Results The gestational age and birth weight of the death group were lower than those of the survival group[29.4(26.8-35.3)weeks vs.32.8(30.1-37.2)weeks,1050.0(737.5-2162.5)g vs.1700.0(1212.5-2587.5)g,Z values were-2.16 and-2.30,both P<0.05].Compared with the survival group,the proportion of asphyxia[45.5%(10/22)vs.21.6%(19/88)],low temperature[27.3%(6/22)vs.8.0%(7/88)],mechanical ventilation[100.0%(22/22)vs.54.5%(48/88)],disseminated intravascular coagulation[22.7%(5/22)vs.3.4%(3/88)],persistent pulmonary hypertension[36.4%(8/22)vs.11.4%(10/88)]and pulmonary hemorrhage[40.9%(9/22)vs.8.0%(7/88)]were higher in the death group(χ^(2)=5.16,4.59,15.71,7.09,6.32 and 12.84,all P<0.05).The VIS values at 24 hours and 48 hours after admission in the death group were 15.0(10.0-18.1)and 18.8(12.8-30.0),respectively,which were higher than those in the survival group[10.0(7.5-10.0)and 10.0(7.5-10.0),Z values were-4.60 and-4.94,respectively,both P<0.05].Logistic regression analysis showed that 24-h VIS value(OR=1.163,95%CI:1.018-1.328),48-h VIS value(OR=1.114,95%CI:1.031-1.204),birth asphyxia(OR=3.815,95%CI:1.017-14.310),and pulmonary hemorrhage(OR=4.470,95%CI:1.174-17.017)were independent risk factors for death(all P<0.05).ROC curve analysis showed that the optimal cutoff value for predict

关 键 词：新生儿 早发型败血症 血管活性正性肌力药物评分 受试者工作特征曲线 

分 类 号：R722.1[医药卫生—儿科]