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目的:构建预测食管闭锁(congenital esophageal atresia,CEA)新生儿院内病死的量化评分系统。方法:比较2004年3月至2016年5月在重庆医科大学附属儿童医院收诊的198例CEA患儿相关指标,分析导致CEA预后不良的独立危险因素并量化赋值。结果:CEA病死率为18.1%(n=36)。单因素分析发现病死组早产、低出生体质量、吻合口漏、长距型CEA、呼吸衰竭、手术后败血症、呼吸窘迫综合征、气胸及休克患病率高于存活组(P<0.05)。logistic回归分析发现吻合口漏(OR=10.75,95%CI=3.113~37.128)、呼吸衰竭(OR=4.104,95%CI=2.292~7.355)、手术后败血症(OR=3.564,95%CI=1.516~8.375)、低出生体质量(OR=8.379,95%CI=3.357~20.917)与高病死率有关(P<0.05)。依据各危险变量赋值构建的受试者工作曲线的曲线下面积为0.902,界点分数为2,灵敏度、特异度、阳性及阴性预测值分别为0.861、0.827、0.525、0.964。低危险(0~1分)、中危险(2~4分)、高危险组(≥5分)病死率分别为3.6%、49.1%、100%,3组比较差异有统计学意义(χ2=73.198,P=0.000)。结论:吻合口漏、呼吸衰竭、手术后败血症、低出生体质量与CEA预后不良有关,在总分为8分的本系统中,得分越高预后越差。
Objective: To construct a quantitative scoring system for predicting nosocomial death in neonates with congenital esophageal atresia (CEA). Methods: The data of 198 children with CEA who were admitted to Children’s Hospital of Chongqing Medical University from March 2004 to May 2016 were compared, and the independent risk factors leading to poor prognosis of CEA were analyzed and quantified. Results: CEA mortality was 18.1% (n = 36). Univariate analysis found that the prevalence of preterm birth, low birth weight, anastomotic leakage, long-range CEA, respiratory failure, postoperative sepsis, respiratory distress syndrome, pneumothorax and shock in the deceased group were higher than those in the survivor group (P <0.05). Logistic regression analysis showed that anastomotic leakage (OR = 10.75,95% CI = 3.113 ~ 37.128), respiratory failure (OR = 4.104,95% CI = 2.292-7.355), postoperative sepsis (OR = 3.564, 95% CI 1.516 ~ 8.375). The low birth weight (OR = 8.379, 95% CI = 3.357 ~ 20.917) was associated with high mortality (P <0.05). The area under the curve of the working curve constructed by assignment of each risk variable was 0.902, the cutoff point was 2, and the sensitivity, specificity, positive and negative predictive values were 0.861, 0.827, 0.525 and 0.964, respectively. The mortality of low risk (0 ~ 1), moderate risk (2 ~ 4), high risk (≥5) were 3.6%, 49.1%, 100% respectively. There was significant difference between the three groups (χ2 = 73.198, P = 0.000). Conclusions: Anastomotic leakage, respiratory failure, postoperative sepsis and low birth weight are associated with poor prognosis in CEA. The higher the score, the poorer the prognosis is in this system with a total score of 8.