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目的探讨新生儿败血症预后的相关因素,为早期预后评估及临床治疗提供理论依据。方法前瞻性入选87例新生儿败血症病例,对其与院内预后(生存或死亡)相关的18个循证变量进行分析。结果 (1)单因素分析显示:病死患儿与存活患儿在吃奶改变、哭声变化、合并休克、合并多器官功能衰竭综合征(MODS)、是否机械通气、病原菌种类、中性粒细胞绝对计数(PMN)、血小板计数(PLT)和小儿危重病例评分(PCIS)的暴露水平差异有统计学意义。(2)多因素分析显示:休克(OR=3.425)、MODS(OR=5.899)、PLT(OR=0.168)、PCIS[OR=0.148(70～80分),OR=0.083(>80分)]是预测预后的独立因素,4个独立因素所建立预报概率模型判断患儿死亡的受试者工作特征曲线(ROC)下面积(0.883)大于任何单一指标。结论合并休克及MODS是新生儿败血症预后的危险因素,检测PLT水平和PCIS有助于预后判断。以多个综合指标评估预后的效能更佳。
Objective To explore the prognosis of neonatal sepsis related factors for the assessment of early prognosis and clinical treatment to provide a theoretical basis. Methods A total of 87 neonatal sepsis cases were enrolled prospectively and 18 evidence-based variables associated with in-hospital prognosis (survival or death) were analyzed. Results (1) Univariate analysis showed that changes of feeding and feeding, cries of crying changes, combined shock, multiple organ dysfunction syndrome (MODS), mechanical ventilation, pathogen species, neutrophils There were significant differences in the levels of PMN, PLT and PCIS. (2) Multivariate analysis showed that there were significant differences in the scores of shock (OR = 3.425), MODS (OR = 5.899), PLT (OR = 0.168) Is an independent predictor of prognosis. The area under the receiver operating characteristic curve (ROC) of children’s death determined by four independent predictors was greater than any single indicator. Conclusion Combined shock and MODS are risk factors for the prognosis of neonatal sepsis. Detecting PLT levels and PCIS may be helpful in predicting prognosis. Prognosis is better evaluated with multiple composite measures.