中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
Chinese Pediatric Emergency Medicine
2015年
10期
714-717
,共4页
陆文峰%王丽杰%刘春峰%张洁
陸文峰%王麗傑%劉春峰%張潔
륙문봉%왕려걸%류춘봉%장길
危重病%危重病评分%预后%儿童
危重病%危重病評分%預後%兒童
위중병%위중병평분%예후%인동
Critical illness%Critical care scores%Prognosis%Children
目的：探讨与分析急性生理学及慢性健康状况评分系统(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)、序贯器官衰竭估计评分(sequential organ failure assessment,SOFA )、小儿死亡风险评分(pediatric risk of mortality score,PRISM)、小儿危重病例评分(pediatric critical illness score,PCIS)、小儿死亡指数(paediatric index of mortality,PIM)5种常用的评分系统在儿科重症病例中判断病情轻重、评估预后的效果；同时筛选出适用于我院 PICU 的危重症评分。方法选取2013年1月至2014年12月我院 PICU 全部院内死亡病例42例为死亡组,选取存活(或治愈)患儿444例为存活组,分别予评估入院时 APACHE Ⅱ、SOFA、PRISM、PCIS、PIM 5项评分；分析死亡组与存活组各项评分的差异。结果死亡组与存活组入院时 APACHE Ⅱ、SOFA、PCIS、PRISM、PIM这5种重症评分的差异均有统计学意义(13.43±8.70 vs.3.48±3.94；78.38±9.33 vs.88.24±6.84；0.1420±0.2147 vs.0.0153±0.0307；5.48±3.42 vs.1.73±1.94；22.02±8.48 vs.12.68±4.88,P 均＜0.001)。APACHE Ⅱ、SOFA、PCIS、PRISM、PIM 这5种重症评分的工作特征曲线下面积(95% CI)分别为0.854(0.798,0.910)、0.838(0.778,0.898)、0.881(0.828,0.934)、0.808(0.748,0.869)、0.936(0.913,0.960),PIM的曲线下面积显著高于其他评分。结论5种评分用于评估疾病轻重程度均有效,对评判预后、评估病情严重程度有很好的鉴别能力,尤以 PIM更加显著。
目的：探討與分析急性生理學及慢性健康狀況評分繫統(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)、序貫器官衰竭估計評分(sequential organ failure assessment,SOFA )、小兒死亡風險評分(pediatric risk of mortality score,PRISM)、小兒危重病例評分(pediatric critical illness score,PCIS)、小兒死亡指數(paediatric index of mortality,PIM)5種常用的評分繫統在兒科重癥病例中判斷病情輕重、評估預後的效果；同時篩選齣適用于我院 PICU 的危重癥評分。方法選取2013年1月至2014年12月我院 PICU 全部院內死亡病例42例為死亡組,選取存活(或治愈)患兒444例為存活組,分彆予評估入院時 APACHE Ⅱ、SOFA、PRISM、PCIS、PIM 5項評分；分析死亡組與存活組各項評分的差異。結果死亡組與存活組入院時 APACHE Ⅱ、SOFA、PCIS、PRISM、PIM這5種重癥評分的差異均有統計學意義(13.43±8.70 vs.3.48±3.94；78.38±9.33 vs.88.24±6.84；0.1420±0.2147 vs.0.0153±0.0307；5.48±3.42 vs.1.73±1.94；22.02±8.48 vs.12.68±4.88,P 均＜0.001)。APACHE Ⅱ、SOFA、PCIS、PRISM、PIM 這5種重癥評分的工作特徵麯線下麵積(95% CI)分彆為0.854(0.798,0.910)、0.838(0.778,0.898)、0.881(0.828,0.934)、0.808(0.748,0.869)、0.936(0.913,0.960),PIM的麯線下麵積顯著高于其他評分。結論5種評分用于評估疾病輕重程度均有效,對評判預後、評估病情嚴重程度有很好的鑒彆能力,尤以 PIM更加顯著。
목적：탐토여분석급성생이학급만성건강상황평분계통(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)、서관기관쇠갈고계평분(sequential organ failure assessment,SOFA )、소인사망풍험평분(pediatric risk of mortality score,PRISM)、소인위중병례평분(pediatric critical illness score,PCIS)、소인사망지수(paediatric index of mortality,PIM)5충상용적평분계통재인과중증병례중판단병정경중、평고예후적효과；동시사선출괄용우아원 PICU 적위중증평분。방법선취2013년1월지2014년12월아원 PICU 전부원내사망병례42례위사망조,선취존활(혹치유)환인444례위존활조,분별여평고입원시 APACHE Ⅱ、SOFA、PRISM、PCIS、PIM 5항평분；분석사망조여존활조각항평분적차이。결과사망조여존활조입원시 APACHE Ⅱ、SOFA、PCIS、PRISM、PIM저5충중증평분적차이균유통계학의의(13.43±8.70 vs.3.48±3.94；78.38±9.33 vs.88.24±6.84；0.1420±0.2147 vs.0.0153±0.0307；5.48±3.42 vs.1.73±1.94；22.02±8.48 vs.12.68±4.88,P 균＜0.001)。APACHE Ⅱ、SOFA、PCIS、PRISM、PIM 저5충중증평분적공작특정곡선하면적(95% CI)분별위0.854(0.798,0.910)、0.838(0.778,0.898)、0.881(0.828,0.934)、0.808(0.748,0.869)、0.936(0.913,0.960),PIM적곡선하면적현저고우기타평분。결론5충평분용우평고질병경중정도균유효,대평판예후、평고병정엄중정도유흔호적감별능력,우이 PIM경가현저。
Objective To investigate the effect of several scoring systems including of acute physiol-ogy and chronic health evaluation Ⅱ (APACHE Ⅱ)score,sequential organ failure assessment (SOFA) score,pediatric risk of mortality score(PRISM),pediatric critical illness score(PCIS)and paediatric index of mortality(PIM)in estimating the prognosis of illness in pediatric severe cases.To select a more appropriate scoring system for PICU.Methods From January 2013 to December 2014,486 cases admissed in PICU of Shengjing Hospital of China Medical University were enrolled in the study,including 42 hospital death cases (dead group)and 444 survived or cured cases(survival group).We estimated each patient with APACHEⅡ,SOFA,PCIS,PRISM and PIM on admission and compared the scores between dead group and survival group.Results The results of APACHE Ⅱ,SOFA,PCIS,PRISM,PIM showed significant defferences be-tween dead group and survival group(13.43 ±8.70 vs.3.48 ±3.94;78.38 ±9.33 vs.88.24 ±6.84;0.142 0 ±0.214 7 vs.0.015 3 ±0.030 7;5.48 ±3.42 vs.1.73 ±1.94;22.02 ±8.48 vs.12.68 ±4.88,P <0.001 ). Areas under the receiver operating characteristic curves of APACHE Ⅱ,SOFA,PRISM,PCIS and PIM (95%CI)were 0.854 (0.798,0.910 ),0.838 (0.778,0.898 ),0.881 (0.828,0.934 ),0.808 (0.748, 0.869),0.936(0.913,0.960).Areas under the receiver operating characteristic curves of PIM was the lar-gest.Conclusion All the 5 kinds of severe scoring systems are effective and have a good ability to asses the prognosis and severity of diseases.It seems that PIM is the most effective.
