两种小儿危重病评分法临床应用的比较

目的 探讨小儿危重病护理评分法的临床应用,并与中华医学分会儿科学急诊组于1995年在全国推广的小儿危重病评分法（草案）进行比较。方法 对2005年5月至2006年4月收治的1029例患儿,应用小儿危重病护理评分系统及小儿危重病评分法（草案）,于入院时、入院后24、487、2 h分别进行评分,并于第7天及出院前再次评分,同时进行器官功能衰竭的评估及预后分析。评分≤70分为病情极危重组,71-80分为危重组,81-100分为非危重组。结果 不论是入院时,还是入院后24 h,各组患儿两种评分方法间无统计学差异（P〉0.05）;首次小儿危重评分值越低,病死率或自动放弃治疗的发生率越高,发生功能衰竭的器官数越多,差异有统计学意义（P〈0.05）;不同病情患儿出现放弃和死亡的病例有统计学差异,但两种评分方法间无统计学差异。结论 应用小儿危重病评分法能帮助判断病情及预后,对临床护理有指导意义,在儿科ICU和普通病房均有推广价值;两种评分法在一定程度上均能量化评价疾病危重的程度,并且符合率较高,其中危重病护理评分系统采用指标全面,更符合儿科临床护理特点。

Application of Two Kinds of Danger Scoring Systems in Critical Ill Children.a Comparatire Study

Objective To discuss the application of danger scoring system in nursing critical ill children,and to compare it with the system for evaluating danger of the children with critical diseases(draft,released nationally in 1995).Methods A total of 1 029 child patients treated in our department from May 2005 to April 2006 were investigated by the 2 evaluating systems at admission,24 h,48 h,72 h,and 7 days after admission and before discharge.Meanwhile,organs failure and prognosis of patients were appraised:Patients in Group I had a score no more than 70 scores(very dangerous);those in Group II had a score of 71-80(dangerous),and those in Group III had a score of 81-100(not dangerous).Results There was no significant difference between the 2 evaluating systems at admission and 24 h after admission(P<0.05).The lower the score at first appraisement was,the higher the mortality and giving up treatment were,the more the failure of organs was(P<0.05).There was significant difference in mortality and giving up treatment between patients with different scores,but the 2 evaluating methods had no significant difference.Conclusion The application of danger evaluating system for children with critical diseases is helpful for clinical nursing and is worth populating in and outside ICU.The 2 evaluating systems can quantitatively reflect the degree of illness with high accuracy.The nursing appraisement system in this study has more indices and is more suitable for pediatric nursing.