小儿危重病例评分法(草案)临床应用的评价

Evaluation of pediatric critical illness scoring system in clinical application

目的用小儿危重病例评分法（草案）评估患儿病情的严重程度。方法对１２所三级医院小儿加强医疗病房中的１２３５例患儿进行了危重病例评分及器官功能衰竭的评估。评分值从高到低分为：～１００、～８０、０～７０３个组，依次代表病情非危重、危重、极危重。住院期间共进行４次评分。结果首次评分显示：非危重、危重、极危重患儿病死率依次为３．２％、１０．２％、２５．２％，各组差异有非常显著意义（Ｐ＜０．０１）。以后各次评分结果与首次评分相似，分值越低病死率越高。１、２、３、３个以上器官功能衰竭分别占３１．９％、１９．５％、１０．６％、３．５％，病死率依次为４．８％、７．４％、２６．５％、５３．８％，差异有非常显著意义（Ｐ＜０．０１）。非危重、危重、极危重患儿多系统器官功能衰竭发生率依次为１５．４％、４７．５％、８３．０％，差异有非常显著意义（Ｐ＜０．０１）。结论小儿危重病例评分可准确判断病情轻重，分值越低，器官功能衰竭越多，病死率亦越高。

Objective To employ pediatric critical illness score (PCIS) to evaluate severity of critical illness in infants and children. Methods A total of 1 235 patients were scored using PCIS and system organ failure (SOF) was evaluated in ICUs of 12 tertiary hospitals. Scores were divided into three groups:～100, ～80, and 0～70, which represented non serious, serious, and extremely serious patients, respectively. During hospitalization patients were scored four times. Results The results of the first scoring showed that mortality rates for non serious, serious, and extremely serious patients were 3.2%, 10.2%, and 25.2%, respectively. These differences were statistically significant ( P <0.01). Results of the second, third, and fourth scoring were similar to those of the first scoring. The lower the scores were, the higher the mortality rate. The occurrence rates of SOF related to one, two, three,and over three systems of organs were 31.9%, 19.5%, 10.6%, and 3.5%, respectively. The mortality rates were 4.8%, 7.4%, 26.5%, and 53.8%, respectively. These differences were statistically significant ( P <0.01). The occurrence rates of multiple system organ failure (MSOF) were 15.4%, 47.5%, and 83.0% in non serious, serious, and extremely serious patients, respectively( P <0.01). Conclusion PCIS may be used to evaluate severity of illness accurately. Lower PCIS indicates higher mortality rate and occurrence rate of MSOF.