新生儿危重病例评分法在新生儿呼吸窘迫综合征中的应用
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摘要
目的探讨新生儿危重病例评分(NCIS)在新生儿呼吸窘迫综合征(NRDS)中的适用性及其临床意义。方法选择2015年1月至2016年12月扬州大学医学院附属医院收治的NRDS患儿70例,按胎龄分为早期早产儿组(胎龄<34周)46例、晚期早产儿组(胎龄34～36+6周)16例和足月儿组(胎龄≥37周)8例。对全部患儿采用NCIS法10项评定、总分100分的评分方式来进行评分,初次评分在入NICU后24h内进行,隔天评分1次,取其最危重分值,如病情加重者立即评分,取最危重分值,病情继续恶化者,每天评分直至死亡为止,总分值>90分者为非危重,70～90分者为危重,<70分者为极危重,另对于符合单项指标一项或一项以上者亦可判定为新生儿危重病例。结果非危重病例在3组间发生率均较低,差异无统计学意义(P>0.05);危重病例在早期早产儿组和晚期早产儿组中的发生率均较高,但与足月儿组相比差异无统计学意义(P>0.05);极危重病例在足月儿组中的发生率最高,且与早期早产儿组、晚期早产儿组相比差异有统计学意义(P<0.05)。非危重病例中无死亡病例,3组极危重病例的死亡率均较高,且与非危重、危重病例比较差异有统计学意义(P<0.05)。结论 NCIS法对评估NRDS病情的严重程度及发展趋势有较好的帮助,还能用于预测死亡风险,并且为继续治疗及与家属沟通提供一定的依据。
Objective To explore the applicability and clinical significance of neonatal critical case scoring(NCIS)in neonatal respiratory distress syndrome(NRDS).Methods A total of 70 cases of NRDS child patients admitted to the Affiliated Hospital of Medical College of Yangzhou University from January 2015 to December 2016 were selected and divided into early preterm infant group(gestational age<34 weeks,n=46)and late preterm infant group(gestational age between 34 and 36+6 weeks,n=16)and full-term infant group(gestational age≥37 weeks,n=8)according to the gestational age.All children were scored by the 10 items of NCIS method with a total score of 100 points.The initial scoring was performed within 24 hafter entering NICU;the scoring was performed every other day,and the most critical score was taken;the patients with aggravation were scored immediately and the taken most critical score was taken;the patients with increasing aggravation were scored every day until the day of death.The children with a total score>90 points were non-critical,70 to 90 points,critical,and<70 points,extremely critical.The patients with one or more than one item of single index might also be judged as neonatal critical cases.Results The incidence rate of non-critical cases was low among the three groups(P>0.05).The incidence rate of critical cases was high in early preterm infant group and late preterm infant group,but the difference was not statistically significant compared with that in full-term preterm group(P>0.05).The incidence rate of extremely critical cases was highest in the full-term infant group,and there was a significant difference compared with early preterm infant group and late preterm infant group(P<0.05).There were no deaths in non-critical cases;the death rate in extremely critical cases was high among the three groups,and there was a significant difference compared with non-critical cases and critical cases(P<0.05).Conclusion NCIS method is helpful to assess the severity and development trend of NRDS,and it can also be used to predict the risk of death and provide a basis for continuing treatment and communication with family members.
Objective To explore the applicability and clinical significance of neonatal critical case scoring(NCIS)in neonatal respiratory distress syndrome(NRDS).Methods A total of 70 cases of NRDS child patients admitted to the Affiliated Hospital of Medical College of Yangzhou University from January 2015 to December 2016 were selected and divided into early preterm infant group(gestational age<34 weeks,n=46)and late preterm infant group(gestational age between 34 and 36+6 weeks,n=16)and full-term infant group(gestational age≥37 weeks,n=8)according to the gestational age.All children were scored by the 10 items of NCIS method with a total score of 100 points.The initial scoring was performed within 24 hafter entering NICU;the scoring was performed every other day,and the most critical score was taken;the patients with aggravation were scored immediately and the taken most critical score was taken;the patients with increasing aggravation were scored every day until the day of death.The children with a total score>90 points were non-critical,70 to 90 points,critical,and<70 points,extremely critical.The patients with one or more than one item of single index might also be judged as neonatal critical cases.Results The incidence rate of non-critical cases was low among the three groups(P>0.05).The incidence rate of critical cases was high in early preterm infant group and late preterm infant group,but the difference was not statistically significant compared with that in full-term preterm group(P>0.05).The incidence rate of extremely critical cases was highest in the full-term infant group,and there was a significant difference compared with early preterm infant group and late preterm infant group(P<0.05).There were no deaths in non-critical cases;the death rate in extremely critical cases was high among the three groups,and there was a significant difference compared with non-critical cases and critical cases(P<0.05).Conclusion NCIS method is helpful to assess the severity and development trend of NRDS,and it can also be used to predict the risk of death and provide a basis for continuing treatment and communication with family members.
引文
[1]闫小红,刘云,李宗尚.新生儿急性呼吸窘迫综合征发病相关因素分析[J].中国中西医结合儿科学,2013,5(4):334-336.
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[6]李耿,喻文亮,于学军,等.小儿危重病例评分和死亡指数在急性呼吸窘迫综合征中的应用[J].中华急诊医学杂志,2007,16(5):518-521.
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[9]陈克正,吕回,赖月华,等.新生儿疾病危重度评分系统的临床应用[J].中国实用儿科杂志,2002,17(4):207-210.
[10]Liu J,Shi Y,Dong JY,et al.Clinical characteristics,diagnosis and management of respiratory distress syndrome in full-termneonates[J].Chin Med J(Engl),2010,123(19):2640-2644.
[11]周冬,单若冰,于海青.新生儿疾病危重评分与美国新生儿紧急生理学评分的比较[J].小儿急救医学,2003,10(4):215-216.
[12]张娟,杨冬.不同胎龄组新生儿呼吸窘迫综合征的临床特点研究[J].中国儿童保健杂志,2013,21(7):749-751.
[13]Jain L,Eaton DC.Physiology of fetal lung fluid clearance and the effect of labor[J].Semin Perinatol,2006,30(1):34-43.
[14]谢露,王钰,曲雯雯,魏巍,范含笑,尹晓娟.足月新生儿呼吸窘迫综合征支气管肺泡灌洗液表面活性蛋白B的表达[J].中华临床医师杂志(电子版),2012,6(9):2496-2498.
[15]尹晓娟,谢露,池婧涵,等.SP-B遗传缺陷导致足月儿新生儿呼吸窘迫综合征三例[J].中国新生儿科杂志,2011,26(4):268.
[2]何柳,夏斌,虎春元,等.新生儿危重病例评分法的临床应用[J].中华妇幼临床医学杂志(电子版),2017,13(2):162-168.
[3]中华医学会急诊分会儿科学组,中华医学会儿科学分会急诊学组,新生儿学组.新生儿危重病例评分法(草案)[J].中华儿科杂志,2001,39(1):42.
[4]胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2002:458-462.
[5]单若冰,王晓亮,谭丽群,等.新生儿疾病危重度评分预测死亡风险比较[J].中华急诊医学杂志,2005,14(4):335-337.
[6]李耿,喻文亮,于学军,等.小儿危重病例评分和死亡指数在急性呼吸窘迫综合征中的应用[J].中华急诊医学杂志,2007,16(5):518-521.
[7]Tita AT,Landon MB,Spong CY,et al.Timing of elective repeat cesarean delivery at term and neonatal outcomes[J].N Engl J Med,2009,360(2):111-120.
[8]单若冰,李跃,郭娜.新生儿疾病危重度评分与临床危险指数评分预测极低体重儿死亡风险的比较[J].临床儿科杂志,2006,24(11):878-880.
[9]陈克正,吕回,赖月华,等.新生儿疾病危重度评分系统的临床应用[J].中国实用儿科杂志,2002,17(4):207-210.
[10]Liu J,Shi Y,Dong JY,et al.Clinical characteristics,diagnosis and management of respiratory distress syndrome in full-termneonates[J].Chin Med J(Engl),2010,123(19):2640-2644.
[11]周冬,单若冰,于海青.新生儿疾病危重评分与美国新生儿紧急生理学评分的比较[J].小儿急救医学,2003,10(4):215-216.
[12]张娟,杨冬.不同胎龄组新生儿呼吸窘迫综合征的临床特点研究[J].中国儿童保健杂志,2013,21(7):749-751.
[13]Jain L,Eaton DC.Physiology of fetal lung fluid clearance and the effect of labor[J].Semin Perinatol,2006,30(1):34-43.
[14]谢露,王钰,曲雯雯,魏巍,范含笑,尹晓娟.足月新生儿呼吸窘迫综合征支气管肺泡灌洗液表面活性蛋白B的表达[J].中华临床医师杂志(电子版),2012,6(9):2496-2498.
[15]尹晓娟,谢露,池婧涵,等.SP-B遗传缺陷导致足月儿新生儿呼吸窘迫综合征三例[J].中国新生儿科杂志,2011,26(4):268.