小儿危重病例评分联合格拉斯哥昏迷量表评分及视频脑电图对小儿重症病毒性脑炎预后的评估价值研究

背景　小儿危重病例评分（PCIS）广泛应用于临床小儿重症病例病情的评估中，格拉斯哥昏迷量表（GCS）被推荐用于评估重症患者的脑功能，而脑电图被认为是预测脑损伤的重要指标，目前国内外关于三者联合用于小儿重症病毒性脑炎（SVE）预后评估的研究较少。目的　探讨PCIS联合GCS评分及视频脑电图（VEEG）对小儿SVE预后的评估价值。方法　采用回顾性分析方法，选取玉林市妇幼保健院重症病房2013年1月-2018年10月诊治的小儿SVE 113例为研究对象。根据预后将患儿分为预后良好组〔37例，儿童格拉斯哥预后量表（CGOS）评级4~5级〕和预后不良组（76例，CGOS评级1~3级）。比较两组患儿临床资料、脑脊液检查及PCIS、GCS评分、VEEG，分析影响小儿SVE预后的危险因素，比较3项独立指标与联合指标（3项指标联合）对小儿SVE预后的评估价值。结果　预后良好组痊愈18例，19例有轻度后遗症；预后不良组5例死亡，25例留有严重后遗症，46例有中度后遗症。多因素Logistic回归分析结果显示，PCIS≤80分及VEEG中度异常、重度异常是小儿SVE预后的危险因素（OR=12.626、512.020、160.712），GCS评分>8分是其保护因素（OR=0.042）（P<0.05）。PCIS、GCS评分、VEEG及联合指标评估小儿SVE预后的受试者工作特征曲线下面积（AUC）分别为0.793、0.615、0.705、0.888，联合指标评估小儿SVE预后的AUC大于PCIS、GCS评分、VEEG（Z=2.834、5.043、3.484，P<0.05）；PCIS评估小儿SVE预后的AUC大于GCS评分（Z=3.248，P=0.001）。结论　PCIS≤80分及VEEG中度异常、重度异常等因素为小儿SVE预后的危险因素，GCS评分>8分为小儿SVE预后的保护性因素。联合评估法对疾病预后预测的准确度相对PCIS、GCS评分、VEEG的独立评估更加优良。

Prognostic Value of Pediatric Critical Illness Score in Combination with Glasgow Coma Scale and Video EEG Monitoring in Severe Viral Encephalitis in Children

Background　Pediatric Critical Illness Score（PCIS） is widely used in evaluating severe pediatric patients.Glasgow Coma Scale（GCS） is recommended for the evaluation of brain function in critically ill patients.Electroencephalogram（EEG） monitoring is considered to be an important predictive method of brain injury.There are few reports about predicting the prognosis of children with severe viral encephalitis by PCIS in combination with GCS score and video EEG（VEEG） monitoring.Objective　To explore the prognostic value of PCIS combined with GCS score and VEEG monitoring in severe viral encephalitis in children.Methods　A retrospective analysis was conducted on 113 children with severe viral encephalitis treated in the ICU Ward，Yulin Maternal and Child Health Hospital between January 2013 and October 2018，including 37 with good prognosis（4-5 points） and 76 with poor prognosis（1-3 points） evaluated by the Child Glasgow Outcome Scale.The clinical data，CSF examination，PCIS，GCS score and VEEG of the two groups were compared to identify the risk factors for the prognosis of severe viral encephalitis.Values of PCIS，GCS score and VEEG monitoring，alone and in combination in predicting the prognosis of severe viral encephalitis were compared.Results　In good prognosis group，18 cases were cured and 19 had mild sequelae.In contrast，in poor prognosis group，5 died，25 had severe sequelae，and 46 had moderate sequelae.Multivariate Logistic regression analysis showed that adverse prognostic factors for severe viral encephalitis were as follows：PCIS≤80，moderate VEEG abnormalities，and severe VEEG abnormalities（OR=12.626，512.020 and 160.712，P<0.05）.And GCS score > 8 was associated with decreased risk of poor prognosis（OR=0.042，P<0.05）.ROC curve analysis showed that the combination of GCS score，PCIS and VEEG monitoring had a larger AUC than GCS score（0.888 vs 0.615，Z=5.043），PCIS（0.888 vs 0.793，Z=2.834），VEEG monitoring（0.888 vs 0.705，Z=3.484） alone（P<0.05） in predicting the prognosis of severe viral encephalitis.And PCIS showed a greater AUC than GCS score（0.793 vs 0.615，Z=3.248，P=0.001）.Conclusion　In children with severe viral encephalitis，PCIS≤80 as well as moderate and severe VEEG abnormalities increased the risk of poor prognosis，while GCS score > 8 decreased the risk.The combination of PCIS，GCS score and VEEG monitoring showed higher accuracy than each alone in predicting the prognosis.