评分法诊断新生儿缺氧缺血性脑病的价值

Diagnosis of Neonatal Hypoxic-Ischemic Encephalopathy by Scoring Method

目的探讨病史、临床表现、化验检查的综合评分评价新生儿缺氧缺血性脑病(HIE)的半定量标准的价值。方法分析颅脑CT和临床确诊的50例HIE患儿的病史、临床表现、化验检查中的多项指标;设定评分和分度标准;与临床和随访综合确定的分度比较,得出评分法诊断的半定量标准,并将此标准用于另41例病例检测。结果确定分度标准为:总分≥20.0分为重度,10.5～19.5分为中度,5.5～10.0分为轻度,≤5.0分不考虑HIE。此评分法分析另外41例,轻度组、中度组、重度组的特异性和敏感性分别为100%和96.9%,97.2%和100%,100%和100%。结论对HIE病情危重不能作头颅CT检查的病例或无条件作头颅CT检查的单位,可应用临床评分法,以诊断HIE和轻重分度。此方法简便易行,对HIE的诊断和轻、中、重度的判断,敏感性和特异性均高。

Objective To approach a semi - quantitative diagnostic criteria of neonatal hypoxic - ischemic encephalopathy（HIE） by comprehensive scoring, including history, clinical manifestation and laboratory data, which can be used for early diagnosis, severity grading and the institution of therapy. Methods We analyzed history, clinical manifestation and some parameters of laboratory data, and established criteria for scoring and grading, and compared this grading with the grading determined by clinical data and follow- up, which brought forward a semi - quantitative diagnostic criteria, and applied this criteria to other 41 patients with HIE to test its reliability. Results The grading criteria were established as the following： if total score ≥20.0, the patient was graded as severe one; total score between 10.5 - 19.5, moderate one; between 5.5 - 10.0, mild one; ≤5.0, non - HIE one. The scoring system was used in other 41 patients with HI E, the specificity and sensitivity were 100 % and 96 . 9 %, 97.2 % and 100 %, 100 % and 100 %, respectively. Conclusions For severe HIE cases who are not permitted to receive compated tomography（CT） examination or no CT can be used, this scoring system can be used to diagnoze HIE and grade the severity. This method is simple and easy to perform. Both specificity and sensitivity are high for diagnosis and severity judgment of HIE.