小儿危重病例评分与儿童死亡风险评分对重症手足口病病情评估和病情进展预测的作用

摘要

[Objective] To compare the performances of pediatric critically illness score (PCIS) and pediat‐ric risk of mortality (PRISM ) in predicting the progression of severe hand ,foot and mouth disease .[Meth‐ods] A total of 424 severe HFMD pediatric patients were recruited from January 1 ,2010 to June 31 ,2013 .on the clinical data of age ,gender ,diagnosis ,length of stay in pediatric intensive care unit (PICU ) ,outcomes and variables were collected for calculating PCIS and PRISM .The area under receiver operating characteristic (ROC) curve was employed to assess the discriminating powers for complications and outcomes .[Results]The length of hospital stay for survivors was longer than that for deceased patients ( P <0 .05) .The incidence of pulmonary edema or pulmonary hemorrhage for deceased patients was higher than for survivors ( P <0 .05) . The median PCIS for deceased patients was lower than that for survivors (Z= -6 .48 ,P =0 .000) .And the median PRISM for deceased patients was higher than that for survivors (Z= -7 .39 ,P=0 .000) .There was a correlation between PCIS and PRISM in assessing the severity of disease .The ROC curve was 0 .74 for PCIS and 0 .78 for PRISM in discriminating pulmonary edema patients .And the ROC curve was 0 .82 for PCIS and 0 .87 for PRISM in discriminating pulmonary hemorrhage patients .The ROC curve was 0 .83 for PCIS and 0 . 87 for PRISM in discriminating deceased patients .[Conclusion] PCIS and PRISM can assessment the severity of HFMD .And a high correlation exists between PCIS and PRISM .Two scores can discriminate children with complications or death .And PRISM is better .%【目的】比较分析小儿危重病例评分（Pediatric Clinical Illness Score ，PCIS）和儿童死亡风险评分（Pediatric Risk of Mortality Score ，PRISM ）对重症手足口病患儿病情进展的预测价值。【方法】选取于2010年1月至2013年6月入住本院重症监护室（ICU ）的符合重症手足口诊断标准的424名患儿。收集小儿PCIS和PRISM评分系统的相关生理参数及结局资料，通过受试者工作特征曲线（ROC）下的面积（AUC）来评估评分系统对并发症和结局的分辨力。【结果】死亡组患儿总住院天数和住IC U天数明显少于存活组患儿，且两者相比较差异有显著性（ P ＜0．05）。死亡组患儿肺水肿和肺出血的发生率明显高于存活组，且两者相比较差异有显著性（ P ＜0．05）。采用PCIS和PRISM评分来评价重症手足口病患儿病情发现，死亡组PCIS评分要明显低于存活组（Z＝－6．48，P ＝0．000），死亡组PRISM 评分明显高于存活组（Z＝－7．39，P ＝0．000），而且两评分系统存在相关性。PCIS和PRISM两评分系统分辨是否发生肺水肿、肺出血和死亡的AUC分别是0．74和0．78、0．82和0．87、0．83和0．87。【结论】PCIS、PRISM 均能够反映重症手足口病的危重程度，且相关程度高。两评分系统对重症手足口病发生严重并发症或者死亡的分辨力均到达可接受水平，且PRISM评分系统更优。