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目的 简化小儿危重病例评分法。分析用简化评分系统评估患儿病情的效果 ,以期更好地适用于基层医院。方法 对 14家三级医院的 10 36例患儿 ,于入院第 1、3、7天及出院或死亡时进行小儿危重病例评分。原评分 10项指标中 ,依次减去动脉氧分压 (PaO2 )和pH、BUN或肌酐、血钠和血钾 ,余 8、7、5项指标 ,原评分分别乘以 0 8、0 7、0 5形成新的评分系统。分析简化评分系统评估病情与原评估方法的符合率 (应 >80 % )及二者的相关性 ,观察简化后评分体系的病死率变化与原评分法是否一致。结果 首次评分减去 2、3、5项指标后 ,与原病情评估一致的病例分别为 82 6 % (85 6 /10 36 )、80 7% (836 / 10 36 )、6 9 9% (72 4 / 10 36 ) ,显示用 5项指标评估病情符合率较低。简化后第 3、7天和末次评分 ,与原病情评估符合率为 81 5 %～ 97 1%。简化前、后有良好相关性 (r=0 6 2 9～ 0 94 8,P均 <0 0 0 1)。简化后 4次评分 ,非危重、危重、极危重组病死率差异有非常显著性 (χ2 =86 13～74 0 33,P均 <0 0 0 1) ,即评分越低 ,病死率越高。在同一病情状态下 ,简化前后的病死率变化不大。如极危重组首、末次评分原病死率为 2 9 8%、6 7 4 % ,简化后病死率分别为 30 0 %～ 2 7 9%、6 6 3%～6 4 4 %。结论
Objective To simplify pediatric critical case score method. Analysis of the use of simplified scoring system to assess the effect of children’s condition, with a view to better apply to primary hospitals. Methods A total of 10 36 children in 14 tertiary hospitals were scored for critical illness in pediatric patients on the 1st, 3rd, 7th day of admission and on discharge or death. The original score of 10 indicators, followed by subtraction of arterial oxygen tension (PaO2) and pH, BUN or creatinine, serum sodium and potassium, more than 8,7,5 indicators, the original score was multiplied by 0 8,07, 0 5 Form a new rating system. Analyze the coincidence rate (> 80%) of the simplified assessment system and the original assessment method, and the correlation between the simplified assessment system and the original assessment method. Results After the first score was reduced by 2, 3, and 5 indicators, the cases consistent with the original disease evaluation were 82 6% (85 6/10 36), 80 7% (836/1036) and 69 9% (72) 4/10 36), showing that the five indicators to assess the condition with a lower compliance rate. On the 3rd, 7th day and the last score after simplification, the coincidence rates with the original condition were 81 5% ~ 97 1%. Before and after simplification there was a good correlation (r = 0 6 2 9 ~ 0 94 8, P <0 0 0 1). After simplification, the 4 scores, non-critically ill, critically ill, critically ill patients with significant differences in mortality (χ2 = 86 13 ~ 74 0 33, P <0 0 0 1), that is, the lower the score, the higher the mortality rate. In the same condition, the mortality before and after simplification changed little. In the critically ill group, the original case fatality rate was 29.8% and 67.4% respectively, and the post-mortem case fatality rates were 30 0% -27 9% and 6 6 3% -6 4 4% respectively. in conclusion