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中国循证儿科杂志

中国循证儿科杂志 ›› 2018, Vol. 13 ›› Issue (3): 185-189.

• 论著 • 上一篇    下一篇

儿童危重病例评分和第三代儿童死亡危险评分在危重患儿的应用情况

应佳云1, 张铮铮2, 陆国平 1   

  1. 1 复旦大学附属儿科医院 上海，201133；2 复旦大学附属中山医院 上海，200233
  • 收稿日期:2018-03-20 修回日期:2018-06-25 出版日期:2018-06-24 发布日期:2018-06-25
  • 通讯作者: 陆国平

Application of the pediatric critical illness score and the pediatric risk of mortality score Ⅲ in critical ill patients： A cohort study

YING Jia-yun 1, ZHANG Zheng-zheng2 , LU Guo-ping1   

  1. 1 Children's Hospital of Fudan University, Shanghai 201102,China; 2 Zhongshan Hospital of Fudan University , Shanghai 201102,China
  • Received:2018-03-20 Revised:2018-06-25 Online:2018-06-24 Published:2018-06-25
  • Contact: LU Guo-ping

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摘要： 目的：探讨儿童危重病例评分（PCIS）和第三代儿童死亡危险评分（PRISMⅢ）对儿童重症监护室（PICU）患儿疾病严重程度和预后的评估能力。方法：纳入2016年7月21日至2017年7月30日收入复旦大学附属儿科医院（我院）PICU的连续病例。以入PICU后第1个12 h病例资料中最异常记录值行PCIS和PRISMⅢ评分。以出PICU结局分为病死组、转出组和自动出院组；以PICU后28 d随访结局分为死亡组和存活组（自动出院组患儿于出PICU 后28 d行电话随访，病死组+自动出院组死亡亚组为死亡组；转出组+自动出院组存活亚组为存活组。从病史中截取患儿年龄、入院前状态、入PICU时疾病、患儿来源、主要病因、在PICU是否接受过有创机械通气治疗、PICU住院时间等资料。相关性分析采用Pearson相关性分析，用Logistic回归分析法评估两种评分系统各指标对结局的预测作用。结果：685例患儿进入本文分析。①根据出PICU结局，分为病死组100例，转出组442例，自动出院组143例；转出组与病死组或与自动出院组，在年龄、入院前状态、住PICU时间差异有统计学意义，病死组与转出组或与自动出院组比较的入院前心肺复苏差异有统计学意义，病死组与转出组比较的使用血管活性药物，转出组与自动出院组比较时病因为创伤、肿瘤和其他原因差异均有统计学意义。②根据出PICU后28 d随访结局分为死亡组（n=218）和存活组（n=567），其中，自动出院死亡亚组118例，自动出院存活亚组25例，单因素分析显示，PCIS评分中的呼吸、收缩压、pH、PaO2和肌酐/尿素氮在死亡和存活组中差异有统计学意义；PRISMⅢ评分中的收缩压、pH、酸中毒、PaO2、PaCO2、CO2总含量、血尿素氮、PT/APTT、PLT计数和神志状态在死亡和存活组中差异有统计学意义。结论：PCIS和PRISMⅢ均适用于我国PICU评估疾病的严重程度和患儿的预后，其中收缩压、pH对预测死亡和存活结局作用较大。

Abstract: ObjectiveTo evaluate the ability of the pediatric critical illness score (PCIS) and the pediatric risk of mortality score Ⅲ (PRISM Ⅲ) in assessing the severity of the disease and the prognosis of children in intensive care unit (PICU). MethodsWe received continuous cases of PICU from Children's Hospital of Fudan University from July 21, 2016 to July 30, 2017. In PICU, PCIS and PRISM Ⅲ scores were obtained from the most abnormal recorded values of clinical data in the first 12 h. Cases were divided into the death groups, the transfer group and the automatic discharge group by PICU outcomes. Cases were divided into the non-survival group and the survival group by outcomes within 28 days after PICU (the cases in the automatic discharge group were followed up by telephone on the 28th day after PICU). The death subgroup of the automatic discharge group and the death group were the non-survival group; the survival subgroup of the automatic discharge group and the transfer group were the survival group. Age, the state before admission, the disease when entering the PICU, the source of the children, and the main cause, whether in the PICU received invasive mechanical ventilation treatment, PICU hospitalization time and other data were collected from medical history. Correlation analysis was done using Pearson correlation analysis, and logistic regression analysis was used to evaluate the predictive effect of each index on the outcomes of the two scoring systems. ResultsA total of 685 cases were included in the study. According to PICU outcomes, there were 100 cases in the death group, 442 cases in the transfer group, and 143 cases in the automatic discharge group. The following differences were statistically significant: age, pre-hospital status and PICU hospitalization time of the transfer group compared with the death group or the automatic discharge group; pre-hospital cardiopulmonary resuscitation of the death group compared with the automatic discharge group or the transfer group; the use of vasoactive drugs of the transfer group compared with the death group; trauma, tumor and other causes of the main cause in the automatic discharge group and the transfer group. According to the 28-day follow-up outcomes after PICU, the cases were divided into the non-survival group (n=218) and the survival group (n=467), including 118 cases of automatic discharge death subgroup and 25 cases of automatic discharge survival subgroup. Univariate analysis showed that respiratory rate, systolic blood pressure, pH, PaO2, and creatinine/urea nitrogen in the PCIS score were statistically different between the non-survival group and the survival group; systolic blood pressure, pH, acidosis, total content of CO2, PaO2, PaCO2, blood urea nitrogen, PT/APTT, PLT count and conscious state in the PRISM Ⅲ score were statistically different between the non-survival group and the survival group. ConclusionBoth PCIS and PRISM Ⅲ are suitable for the assessment of the severity of disease and the prognosis of children in PICU. Systolic blood pressure and pH have a greater effect on predicting outcomes of death and survival.