危重新生儿评分对转运新生儿的病情评估

Critical neonatal scoring in assessing severity of transported neonates

目的比较新生儿转运生理稳定指数(TRIPS)、新生儿急性生理评分-Ⅱ(SNAP-Ⅱ)、围产期-新生儿急性生理评分-Ⅱ(SNAPPE-Ⅱ)早期评估转运新生儿病情的准确性。方法收集2012-01-01—2012-12-31由重庆医科大学附属儿童医院急救中心转运入住本病房新生儿的临床资料进行回顾性分析,比较TRIPS、SNAP-Ⅱ和SNAPPE-Ⅱ等对7 d内死亡、重度脑室内出血(≥Ⅲ级)以及需要机械通气(MV)的预测准确性。结果共475例新生儿纳入统计。Hosmer-Lemeshow拟合度检验提示三种评分系统模型均有较好的拟合度(P>0.05),P值分别为0.73(TRIPS),0.30(SNAP-Ⅱ)和0.27(SNAPPE-Ⅱ),TRIPS拟合最好。TRIPS、SNAP-Ⅱ、SNAPPE-Ⅱ预测7 d内死亡的受试者工作特征曲线下面积(AUC)分别为0.80,0.82,0.84,预测重度脑室内出血的AUC分别为0.70,0.69,0.83,预测MV的AUC分别为0.72,0.72和0.74;各评分系统预测准确度差异均无统计学意义(P>0.05)。ROC曲线截点分析提示,TRIPS≥20分时,7 d内死亡、需要MV预测的敏感度分别为89.1%,72.5%,特异度分别为57.7%,66.8%。结论与SNAP-Ⅱ、SNAPPE-Ⅱ及NCIS相比,TRIPS评分操作更简便易行,适于临床使用,对新生儿转运后7d内死亡、重度脑室内出血及MV发生率预测的准确性较高。

Objective To evaluate the performance of the Transport Risk Index of Physiologic Stability（TRIPS）,Score forNeonatal Acute Physiology,Version Ⅱ（SNAP-Ⅱ）and Score for Neonatal Acute Physiology-Perinatal Extension,VersionⅡ（SNAPPE-Ⅱ）forseverityoftransportedneonates.MethodsThe study enrolled the neonates transported to Departmentof Neonatology,Children＇s Hospital of Chongqing Medical University from Jan.1 to Dec. 31 of 2012. The clinical data werecollected and analyzed retrospectively to compare the prediction accuracy of 7-day mortality,severe（≥Grade Ⅲ）in-tra-ventricular hemorrhage（IVH）and mechanical ventilation（MV）.ResultsTotally 475 neonates were enrolled.Hos-mer-Lemeshow goodness-of-fit test showed good calibration of the TRIPS（P = 0.73）,SNAP-Ⅱ（P = 0.30）and SNAPPE-Ⅱ（P=0.27）,andtheTRIPSwas thebest. TRIPS,SNAP-ⅡandSNAPPE-Ⅱ discriminated7-daymortalitywithreceiveroperating characteristic area（AUC）of 0.80,0.82 and 0.84,respectively,whereas the predictive performance for severe IVHwas 0.70,0.69 and 0.83,and the performance for MV 0.72,0.72 and 0.74,respectively. There was no significant differenceamong these three scoring systems（P〈0.05）. With the cut-off value of 20 points,the sensibility of TRIPS predicting 7-daymortality and MV was 89.1% and 72.5%,respectively,whereas the specificity 57.7% and 66.8%.ConclusionComparedwith SNAP-Ⅱ,SNAPPE-Ⅱ and NCIS,TRIPS is more suitable for quick severity evaluation due to its simplicity and fea-sibility,especially in accurately predicting 7-day mortality,severe IVH and MV of transported neonates.