简化新生儿危重病例评分法的临床应用评价

目的 通过与2001年发表的新生儿危重病例评分法(NCIS)进行比较,探讨简化新生儿危重病例评分法在临床应用的可行性.方法 这是一项前瞻、对照的临床研究.选取705例2007年1月1日至2009年12月31日首都儿科研究所重症监护病房(NICU)收治的外院转运新生儿,于入院当日、第3,7天及出院或死亡时进行新生儿危重病例评分.首次评分时,在10项评分指标中减去动脉血氧分压(PaO2)和pH,余8项指标;在其后3次评分时,再减去血钠、钾和肌酐或尿素氮,余5项指标,彤成新的简化评分法.分析简化新生儿危重病例评分与原评分方法对病情评估的符合率(>80%)及二者的相关性.结果 人院首次评分使用8项指标,与原病情评估一致的符合率为86.7%,第3,7天和末次评分使用5项指标,与原病情评估一致的符合率为86.6%-95.7%,简化前后有良好的相关性(P<0.01).简化后的首、末次评分,非危重、危重和极危重三组患儿的病死率差异有统计学意义(P<0.01),与NCIS的结果一致;简化前后相同病情程度患儿的病死率差异无统计学意义(P>0.05).结论 与NCIS相比,简化NCIS法对患儿病情的评估基本一致,可以较准确客观评价危重新生儿,是一种简便易行的临床评分方法.

Abstract：

Objective To discuss the clinical application of simplified neonatal critical illness score (sNCTS)in comparison with original neonatal critical illness score(oNCIS)published in 2001.Method A total of 705 neonates referred to neonate ICU(NICU)from 1 st January 2007 to 31th December 2009 were prospectively studied with control.The patients were scored by oNCIS on admission day,3rd,7th days after admission and on the day of discharge or dead.At the first scoring on admission,2 items of the PaO2 and pH were excluded from oNCIS's 10 items,and the remaining 8 items were used.Three items of plasma sodium,potassium and creatinine or BUN were scored out from 8 items and the still remained 5 items were used for the subsequent 3 scorings.The remaining 8 and 5 items were used as a simplified neonatal critical illness score.The simplified NCIS was evaluated by comparing the patients'condition that was assessed by the originat NCIS.The consistency rate between oNCIS and sNCIS should be over 80%.Results There were 8 items were used to evaluate the severity of disease on admission, and the consistence rate was 86.7%with the original NCIS.The 5 items selected from the original NCIS were used on the 3rd,the 7th days and the day of discharge or death.the consistence rate with original NCIS were 86.6%to 95.7%.A close correlation existed between the original NCIS and simplified NCIS(P<0.01).There were significant differences in mortality rates of the non-serious,serious and extremely serious groups between original NCIS and simplifled NCIS used for the first and the last seorings(P<0.01).Within a cohort of neonates with the same general condition,the assessments of mortality rates were not significantly different between these two methods (P>0.05).Conclusions Compared with the original NCIS.the simplified NCIS is consistent to a large extent in disease assessment,which is a concise way to evaluate the critical ill neonates objectively and can be easily applied to clinical practice.

Evaluation of the clinical application of simplified neonatal critical illness score

Objective To discuss the clinical application of simplified neonatal critical illness score (sNCTS)in comparison with original neonatal critical illness score(oNCIS)published in 2001.Method A total of 705 neonates referred to neonate ICU(NICU)from 1 st January 2007 to 31th December 2009 were prospectively studied with control.The patients were scored by oNCIS on admission day,3rd,7th days after admission and on the day of discharge or dead.At the first scoring on admission,2 items of the PaO2 and pH were excluded from oNCIS's 10 items,and the remaining 8 items were used.Three items of plasma sodium,potassium and creatinine or BUN were scored out from 8 items and the still remained 5 items were used for the subsequent 3 scorings.The remaining 8 and 5 items were used as a simplified neonatal critical illness score.The simplified NCIS was evaluated by comparing the patients'condition that was assessed by the originat NCIS.The consistency rate between oNCIS and sNCIS should be over 80%.Results There were 8 items were used to evaluate the severity of disease on admission, and the consistence rate was 86.7%with the original NCIS.The 5 items selected from the original NCIS were used on the 3rd,the 7th days and the day of discharge or death.the consistence rate with original NCIS were 86.6%to 95.7%.A close correlation existed between the original NCIS and simplified NCIS(P<0.01).There were significant differences in mortality rates of the non-serious,serious and extremely serious groups between original NCIS and simplifled NCIS used for the first and the last seorings(P<0.01).Within a cohort of neonates with the same general condition,the assessments of mortality rates were not significantly different between these two methods (P>0.05).Conclusions Compared with the original NCIS.the simplified NCIS is consistent to a large extent in disease assessment,which is a concise way to evaluate the critical ill neonates objectively and can be easily applied to clinical practice.