非心脏手术患儿围术期死亡的危险因素分析和预警系统建立

Risk factors of perioperative mortality in children with non- cardiac surgery and establishment of a risk scoring system

目的探讨非心脏手术患儿围术期死亡的危险因素,建立预测死亡的风险评分系统。方法选择2008年1月至2013年12月0~14岁非心脏手术围术期死亡患儿(57例)及非死亡患儿(114例)的临床资料,对其年龄、BMI、ASA分级、是否早产、手术方式、手术类别、体温、血氧饱和度(SpO_2)、是否饱胃、手术时间、手术次数、WBC、是否贫血、是否低白蛋白、是否凝血功能异常及是否血电解质异常共17项可能的风险因素进行多因素和单因素分析,确定死亡危险因素,建立预测评分系统。结果多因素回归确定非心脏手术患儿围术期死亡的危险因素为:年龄>1岁,BMI<15kg/cm^2、ASA≥3级、SpO_2<96%、饱胃、凝血功能异常(均P<0.05)。非心脏手术患儿围术期死亡发生的风险评分系统如下:年龄<1岁(14分),BMI<15 kg/cm2(17分),ASA≥3级(30分),SpO_2<96%(22分),饱胃(16分),凝血异常(27分)(P<0.05或0.01)。根据方程绘制ROC曲线,所对应的非心脏手术患儿发生死亡的风险得分为30.5分,灵敏度为98.2%,特异度为89.5%。如患儿得分>30.5分,则围术期死亡的发生率大大增加。结论非心脏手术患儿围术期死亡的预警评分系统简单易行,结果可靠,可为围术期死亡的早期发现和干预提供帮助。

Objective To analyze the preoperative risk factors of perioperative mortality in children with non-cardiacsurgery and to establisha risk scoring system. Methods Total 171 children aged 0-14, who underwent non-cardiac surgeryfrom January 2008 to December 2013 of non-cardiac surgery in the Second Affiliated Hospital of Wenzhou Medical University,were enrolled in the study, including 57 cases who died perioperatively and 114 cases who survived. The clinical data includingage, body mass index （BMI）, ASA classification, premature birth, category and types of operations, body temperature, oxygensaturation, full stomach, duration of surgery, number of operations, white blood cell count （WBC）, anemia, albumin levels,electrolyte imbalance were retrospectively analyzed. Univariate and multivariate logistic regression analysis was used todetermine the independent preoperative risk factors. Results Logistic regression analysis identified that low BMI, ASAclassification, SpO2〈96%, full stomach and coagulation abnormality were independent risks factors of perioperative mortality inchildren with non-cardiac surgery（P〈0.05）. The scoring system was set： age〈1y as 14, BMI〈15 as 17, ASA≥3 as 30, SpO2〈96% as 22, full stomach as 16 and coagulation abnormality as 27. For children with total score 〉30.5, the incidence ofperioperative mortality increased significantly. The ROC of risk scores was used in predicting repioperative mortality, and taking30.5 as cut-off value the sensitivity was 0.982 and specificity was 0.895. Conclusion The risk scoring system can effectivelypredict the perioperative mortality for pediatric patients with non-cardiac surgery.