SNAPPE-Ⅱ评分结合Bell分期预测新生儿坏死性小肠结肠炎预后的相关研究

The Related Research of the SNAPPE-Ⅱ Combined with Bell Stage to Predict the Prognosis of Neonatal Necrotizing Enterocolitis

目的:探讨新生儿危重评分新生儿急性生理学评分围产期补充Ⅱ(SNAPPE-Ⅱ)结合Bell分期对预测新生儿坏死性小肠结肠炎(NEC)手术风险及预后的价值。方法:对2009年1月至2013年12月湖南省儿童医院收治的225例NEC患儿的临床资料进行回顾性分析,根据治疗结果分为治愈好转组175例和死亡组50例。统计患儿临床资料,依据SNAPPE-Ⅱ评分与Bell分期对患儿进行分组分期,比较各组、各期之间的病死率以及分析评分与分期之间的相关性。结果:患儿早期最常见症状为腹胀(85.3%);手术组SNAPPE-Ⅱ评分明显高于非手术组(P<0.05);Bell分期Ⅰ期治愈好转率分别与Ⅱa、Ⅱb、Ⅲ期比较差异有统计学意义(P<0.05),Ⅱ期治愈好转率与Ⅲ期比较差异有统计学意义(P<0.05);治愈好转组不同Bell分期的SNAPPE-Ⅱ评分均明显低于死亡组,两组比较差异均有统计学意义(P<0.01);治愈好转组入院时SNAPPE-Ⅱ评分明显低于死亡组,两组比较差异有统计学意义(P<0.01);确诊时,治愈好转组SNAPPE-Ⅱ评分显著低于死亡组,两组比较差异有统计学意义(P<0.01)。结论:Bell分期越严重SNAPPE-Ⅱ评分越高,病死率越高。SNAPPE-Ⅱ评分结合Bell分期能预测NEC的预后及手术风险,对早期预测NEC患儿死亡危险性有重要意义。

Objective： To explore the value of the score of SNAPPE-Ⅱ combined with Bell stage to predict operation risk and prognosis value of neonatal necrotizing enterocolitis（ NEC）. Methods： Two hundreds and twenty five children with NEC were selected from Children＇s Hospital of Hunan Province between January 2009 and December 2013. According to the results of treatment,the children were divided into improved cure group（ 175 cases） and death group（ 50 cases）. Then we did statistics of the children＇s general clinical information. Basis SNAPPE-Ⅱ score and Bell stage of the study children were grouped in installment,and compared between groups or periods of the correlation between mortality,grading and staging. Results： The most common symptom of early NEC was abdominal distension,which accounted for（ 85. 3%）. Mortality of children with different Bell stages had different statistically significant（ P〈0. 05）. The scores of the SNAPPE-Ⅱ of the surgical group were significantly higher than those of the non surgical group（ P〈0. 05）. Improved cure group with different Bell stage SNAPPE-Ⅱ scores were significantly lower than the death group on admission,comparing differences statistically significant（ P〈0. 05）. Conclusion： More serious of Bell stage,higher scores of the SNAPPE-Ⅱ,the mortality is higher. SNAPPE-Ⅱ grade combined with Bell stage maybe used to predict the prognosis of NEC and surgical risks,the scores are good predictors of mortality in the early period when NEC occurs.