危重新生儿评分对转运新生儿的病情评估.doc

危重新生儿评分对转运新生儿的病情评估? ?基金项目：2011年度国家临床重点专科建设项目［卫办医政函2011(873号)］ *通讯作者：华子瑜，E-mail：h_ziyu@163.com 重庆医科大学附属儿童医院新生儿科（400014） 张莉，张先红，黄元英，华子瑜 摘要：目的 比较新生儿转运生理稳定指数（Transport Risk Index of Physiologic Stability，TRIPS）、新生儿急性生理评分-Ⅱ（Score for Neonatal Acute Physiology，Version Ⅱ,SANP-Ⅱ）、围产期-新生儿急性生理评分-Ⅱ（Score for Neonatal Acute Physiology，Perinatal Extension，Version Ⅱ，SNAPPE-Ⅱ）早期评估转运新生儿病情的准确性。方法 收集2012年1月1日至2012年12月31日由我院120转运入住本病房新生儿的临床资料进行回顾性分析，比较TRIPS、SANP-Ⅱ和SNAPPE-Ⅱ等对7天内死亡、重度脑室内出血（≥Ⅲ级）以及需要机械通气的预测准确性。结果 共475例新生儿纳入统计。Hosmer-Lemeshow 拟合度检验提示三种评分系统模型均有较好的拟合度（P＞0.05），P值分别为0.73 (TRIPS)， 0.30（SNAP-Ⅱ）和0.27（SNAPPE-Ⅱ），TRIPS拟合最好。TRIPS、SNAP-Ⅱ、SNAPPE-Ⅱ预测7天内死亡的受试者工作特征曲线下面积（AUC）分别为0.80，0.82，0.84，预测重度脑室内出血的AUC分别为0.70，0.69，0.83，预测机械通气的AUC分别为0.72，0.72和0.74；各评分系统预测准确度均无统计学差异（P＞0.05）。ROC曲线截点分析提示，TRIPS≥20分时，7天内死亡、需要机械通气预测的敏感度分别为89.1%，72.5%，特异度分别为57.7%，66.8%。结论 与SANP-Ⅱ、SNAPPE-Ⅱ及NCIS相比， 关键词 转运新生儿；7天内死亡；重度脑室内出血；机械通气；病情评估 中图分类号 R722.1 Critical neonatal scoring assessing severity of transported neonates Zhang Li, Zhang Xianhong, Huang Yuanying, Hua Ziyu（Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China） Abstract：Objective：To evaluate the performance of the Transport Risk Index of Physiologic Stability (TRIPS), Score for Neonatal Acute Physiology, Version Ⅱ (SANP-Ⅱ) and Score for Neonatal Acute Physiology-Perinatal Extension, Version Ⅱ (SNAPPE-Ⅱ) for severity of transported neonates. Methods：The study enrolled the neonates transported to our department during Jan.1 to Dec. 31 of 2012. The clinical data were collected and analyzed retrospectively to compare the prediction accuracy of 7-day mortality, severe (≥Grade Ⅲ) intra-ventricular hemorrhage (IVH) and mechanical ventilation (MV).Result: 475 neonates were enrolled. Hosmer-Lemeshow goodness-of-fit test showed good calibration of the TRIPS (P=0.73), SANP-Ⅱ (P=0.30) and SNAPPE-Ⅱ(P=0.27), and the TRIPS was the best. TRIPS, SNAP-Ⅱand SNAPPE-Ⅱ discriminated 7-day mortality with receiver operating charac