新生儿感染性休克中全身炎性反应综合征新、旧诊断标准比较

Comparison between the New and Old Diagnostic Criteria of Neonatal Systemic Inflammatory Response Syndrome in Neonatal Septic Shock

目的探讨全身炎性反应综合征（SIRS）新、旧诊断标准对新生儿危重病的指导意义及其间的差异。方法以新生儿休克分度标准、新生儿SIRS新、旧诊断标准及新生儿脏器衰竭诊断标准为基础,对117例新生儿感染性休克进行临床分析。应用SPSS 13.0软件进行统计学分析。结果感染性休克患儿117例中轻度休克20例,中度休克83例,重度休克14例。男90例,女27例。以出生3d内发病为多,多于入院3d内死亡,原发疾病以败血症为主。117例中,符合SIRS旧诊断标准者53例,符合率45.3%;符合SIRS新诊断标准者49例,符合率41.9%。在符合SIRS诊断标准的患儿中,符合2~4项诊断项目的例数及死亡数,新、旧标准间差异均无统计学意义,新、旧标准的符合率及病死率间的差异无统计学意义（Pa〉0.05）。无论新标准还是旧标准,SIRS诊断符合率最高者为体温改变,发生心率改变者较少。117例多伴2、3个脏器衰竭,以呼吸系统衰竭最常见,新、旧标准中符合相同脏器衰竭个数中的病死率的差异亦无统计学意义（P〉0.05）。结论从临床各方面比较,SIRS新、旧诊断标准对危重病判断的符合率均不高,说明SIRS新诊断标准并不比旧标准优越,提示需进一步完善新生儿SIRS诊断标准。

Objective To discuss the guiding significance of new and old neonatal systemic inflammatory response syndrome （SIRS） diag- nostic criteria for neonatal critical illnesses in clinic and the differences between them. Methods A total of 117 septic shock neonates including 90 male and 27 female were under clinical analysis based on neonatal shock score, new and old neonatal SIRS diagnostic criteria and neonatal organic function failure diagnostic criteria. The number of gentle shock, mezzo shock and severe shock were 20,83 and 14 cases. SPSS 13.0 software was used to analyze the data. Results Most cases in 117 septic shock neonates suffered in the first 3 days after birth, most of which were died in the first 3 days of hospitalization. The primary affection mostly was septicemia. In 117 cases, there were 53 cases according to the old SIRS diagnostic criteria,the conforming rate was 45.3% ,and there were 49 cases according to the new SIRS diagnostic criteria,the conforming rate was 41.9%. In the cases according to SIRS diagnostic criteria, there was no significant difference between the new and old Criteria in terms of the number of cases according to 2 - 4 items of diagnostic criteria, the conforming rates and mortalities （ P 〉 0.05 ）. For the new and old SIRS diagnostic criteria, the most common conforming item was the change of body temperature, while the change of heart rate was rare. Most of the 117 cases had combined with 2,3 organic function failures;Respiratory failure was the most common one. There was no signifi- cant difference between the new and old SIRS diagnostic criteria in terms of the mortalities with the same number of failed organs （ P 〉 0.05 ）. Conclusions Neither the new nor old SIRS diagnostic criteria had a high conforning rate with neonatal critical illnesses;There was no signifi- cant difference between them in each clinical item. It shows that the new SIRS diagnostic criteria is not superior to the old one, therefore we should improve the neonatal SIRS diagnostic criteria in the future.