[1]李禄全,余加林,王家蓉,等.建立影响新生儿肺出血病死率危险因素量化评分体系的研究[J].第三军医大学学报,2008,30(15):1473-1477.
 LI Lu-quan,YU Jia-lin,WANG Jia-rong,et al.Risk factors for mortality in neonatal pulmonary hemorrhage: a prediction score model[J].J Third Mil Med Univ,2008,30(15):1473-1477.
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建立影响新生儿肺出血病死率危险因素量化评分体系的研究(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
30卷
期数:
2008年第15期
页码:
1473-1477
栏目:
论著
出版日期:
2008-08-15

文章信息/Info

Title:
Risk factors for mortality in neonatal pulmonary hemorrhage: a prediction score model
作者:
李禄全余加林王家蓉沈和平 张先红张惠蓉
重庆医科大学附属儿童医院新生儿科
Author(s):
LI Lu-quan YU Jia-lin WANG Jia-rong SHEN He-ping  ZHANG Xian-hong ZHANG Hui-rong
Department of Neonatology, Children’s Hospital, Chongqing Medical University, Chongqing 400014, China
关键词:
新生儿肺出血病死率危险因素评分体系
Keywords:
neonate pulmonary haemorrhage mortality risk factor score system
分类号:
R181.21; R725.636
文献标志码:
A
摘要:
目的   探讨影响肺出血新生儿预后的危险因素并建立相应量化评分体系。 方法  回顾性分析244例肺出血新生儿临床资料,用Logistic回归分析等方法筛选影响病死率的危险因素,进行量化评分并绘制受试者工作曲线(receiver operating characteristic curve,ROC),确定诊断界点。 结果  在244例患儿中,病死率为74.59%(182/244),治愈组平均胎龄、日龄中位数与病死组比较,差异无统计学意义(P>0.05),治愈组双胎或三胎发生率、出生体质量与病死组比较,差异有统计学意义(P<0.05)。治愈组呼吸窘迫综合征、呼吸衰竭、寒冷损伤综合征患病率与病死组比较,差异无统计学意义(P>0.05)。治愈组颅内出血、心力衰竭、败血症的患病率显著低于病死组(P<0.01)。对上述差异有统计学意义的变量进行Logistic回归分析,出生体质量、颅内出血、心力衰竭、败血症4个变量入选回归方程,方程预测准确率为80.7%,建立的ROC曲线下面积为0.786,界点为9分时该评分体系预测对肺出血预后灵敏度为84.6%,特异度为66.1%,阳性预测值为88.0%,阴性预测值为59.4%。9分以下组(低度危险组)病死率显著小于10分以上组(高度危险组)(P<0.01)。 结论  Ⅲ度或Ⅳ度颅内出血、出生体质量低、败血症、心力衰竭是影响肺出血新生儿病死率的危险因素,量化评分9分以上则高度危险。
Abstract:
Objective    To explore the risk factors that affect the mortality of neonates with pulmonary haemorrhage (PH) and establish a mortality prediction score model.     Methods    Totally 244 PH infants were analyzed retrospectively. The risk factors were screened out by logistic regression analysis and the scores were developed according to regression coefficients. Then the receiver operating characteristic curve was constructed and the cutoff was determined.     Results    The mortality was 74.59% (182/244), the mean gestational age and median age were (36.513±3.805) weeks and 0.24 days in the survived infants, (35.746±3.929) weeks and 0.33 days in the died infants respectively, without significance between two groups (P>0.05). The rate of twins or triplets and birth weight of the survived infants were 3.2% (2/62), (2 786.866±606.991) g, while 20.1% (25/182), (2 338.812±756.790) g in the died infants (P<0.05). The survived infants had no difference from those died in the rate of neonatal respiratory distress syndrome (43.5% vs 34.6%, χ2=1.585, P=0.208), respiratory failure (77.4% vs 78.6%, χ2=0.036, P=0.849), or cold injury syndrome (35.5% vs 44.5%, χ2=0.396, P=0.529). The survived infants had significant difference from those died in the rate of IVH (25.8% vs 53.8%, χ2=14.607, P=0.000), heart failure (22.6% vs 48.9%, χ2=13.134, P=0.000), sepsis (3.2% vs 16.5%, χ2=7.134, P=0.008). We further used logistic regression analysis to test above significantly different variables, then the four variables (birth weight, IVH, heart failure and sepsis) were in the logistic regression equation. The predicted percentage of correct was 80.7%. According to regression coefficients, a score ranging from 4 to 40 was developed, the area under the receiver operating characteristic curve was 0.786. At a cutoff point of 9, the pulmonary hemorrhage was predicted with the sensitivity of 0.846, the specificity of 0.661, the positive predictive value of 0.88 and the negative predictive value of 0.594. The mortality was higher in the “low risk group” (the score≤9) than that in the “high risk group” (the score>9) (40.6% vs 88%, χ2=58.714, P=0.000).      Conclusion    Low birth weight, IVH, heart failure and sepsis are the risk factors in the prognosis of neonates with pulmonary haemorrhage. The infants with the score higher than 9 are assessed to be at “high risk” for death.

参考文献/References:

李禄全,余加林,王家蓉,等.  建立影响新生儿肺出血病死率危险因素量化评分体系的研究[J].第三军医大学学报,2008,30(15):1473-1477.

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更新日期/Last Update: 2008-07-28