全程优质护理模式、APACHE Ⅱ评分与NIPS评分对NICU新生儿院内感染的预测价值

The predictive value of whole course high-quality nursing mode, APACHE Ⅱ score and NIPS scorein nosocomial infection of newborns in NICU

目的探讨新生儿疼痛评分(NIPS)与急性生理学与慢性健康状况评分(APACHEⅡ)对NICU新生儿院内感染的预测价值以及全程优质护理模式对不良事件发生率的影响。方法采用回顾性的分析方法对2017、2018年的患儿进行回顾性研究,其中2018年1月始采用全程优质护理模式进行护理干预。对我院2017年1月~2018年12月新生儿重症监护(NICU)收治的新生儿256例进行NIPS评分和APPACHEⅡ评分,通过评分对感染率进行预测,预测结果与实际发生率比较,通过受试者操作工作特征曲线下面积(ROC曲线)和诊断结果判断评分模型对感染率的预测能力。比较两年的新生儿院内感染率、不良事件。结果通过ROC曲线下面积分析,APACHEⅡ曲线下面积为(0.93±0.05),NIPS的曲线下面积为(0.84±0.05)。两个年度内患儿NIPS评分、APPACHEⅡ比较差异无统计学意义(P>0.05),2018年度新生儿不良事件发生率明显低于2017年度(P<0.05)。结论NIPS评分与APACHEⅡ评分的变化情况与不良事件发生率显著相关,两种评分具备对NICU新生儿院内感染发生率进行预测的参考价值,采用全程优质护理模式能显著降低高分患儿不良事件发生率。

Objective To explore predictive values of neonatal infant pain scale(NIPS)score and acute physiology and chronic health evaluation(APACHE Ⅱ)score in nosocomial infection of newborns in NICU and effects of whole course high-quality nursing on incidence of adverse events.Methods Retrospective analysis method was adopted to conduct a retrospective study on the children in 2017 and 2018.In January 2018,the whole course highquality nursing mode was used for nursing intervention.Two hundred and fifty-six newborns who were admitted to neonatal intensive care unit(NICU)in our hospital from January 2017 to December 2018 were given NIPS score and APACHE Ⅱ score.The infection rate was predicted by the score,and the predicted result was compared with the actual incidence rate.The ability of the scoring model to predict the infection rate was judged by the area under the receiver operating characteristic curve(ROC curve)and the diagnostic result.The neonatal nosocomial infection rate and adverse events of two years were compared.Results Through the area analysis under the ROC curve,the area under the APACHE Ⅱ curve was(0.93±0.05),and the area under the curve of NIPS was(0.84±0.05).There was no significant difference in NIPS score and APPACHE Ⅱ score of children between two years(P>0.05).The incidence of neonatal adverse events in 2018 was significantly lower than that in 2017(P<0.05).Conclusion The change of NIPS score and APACHE Ⅱ score is significantly correlated with the incidence of adverse events.Both scores have a reference value for predicting the incidence of nosocomial infections in NICU neonates.The use of whole course highquality nursing mode can significantly reduce the incidence of adverse events in children with high scores.