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目的:探讨新生儿危重评分新生儿急性生理学评分围产期补充Ⅱ(SNAPPE-Ⅱ)结合Bell分期对预测新生儿坏死性小肠结肠炎(NEC)手术风险及预后的价值。方法:对2009年1月至2013年12月湖南省儿童医院收治的225例NEC患儿的临床资料进行回顾性分析,根据治疗结果分为治愈好转组175例和死亡组50例。统计患儿临床资料,依据SNAPPE-Ⅱ评分与Bell分期对患儿进行分组分期,比较各组、各期之间的病死率以及分析评分与分期之间的相关性。结果:患儿早期最常见症状为腹胀(85.3%);手术组SNAPPE-Ⅱ评分明显高于非手术组(P<0.05);Bell分期Ⅰ期治愈好转率分别与Ⅱa、Ⅱb、Ⅲ期比较差异有统计学意义(P<0.05),Ⅱ期治愈好转率与Ⅲ期比较差异有统计学意义(P<0.05);治愈好转组不同Bell分期的SNAPPE-Ⅱ评分均明显低于死亡组,两组比较差异均有统计学意义(P<0.01);治愈好转组入院时SNAPPE-Ⅱ评分明显低于死亡组,两组比较差异有统计学意义(P<0.01);确诊时,治愈好转组SNAPPE-Ⅱ评分显著低于死亡组,两组比较差异有统计学意义(P<0.01)。结论:Bell分期越严重SNAPPE-Ⅱ评分越高,病死率越高。SNAPPE-Ⅱ评分结合Bell分期能预测NEC的预后及手术风险,对早期预测NEC患儿死亡危险性有重要意义。
Objective: To investigate the value of SNAP-Ⅱ combined with Bell staging in predicting the surgical risk and prognosis of neonatal necrotizing enterocolitis (NEC) in neonatal critical mass score neonatal acute physiology score. Methods: The clinical data of 225 children with NEC admitted to Children’s Hospital of Hunan Province from January 2009 to December 2013 were retrospectively analyzed. According to the results of treatment, 175 cases were cured and 50 died. Statistics of children with clinical data, according to SNAPPE-Ⅱ score and Bell staging of children were divided into groups, compared between groups, between the mortality and analysis of the correlation between score and staging. Results: The most common symptom of early stage was abdominal distension (85.3%). The score of SNAPPE-Ⅱ in operation group was significantly higher than that in non-operation group (P <0.05). The improvement rate of Bell stage Ⅰ was significantly different from that of Ⅱa, Ⅱb and Ⅲ (P <0.05). The improvement rate of stage Ⅱ was significantly different from that of stage Ⅲ (P <0.05). The SNAPPE-Ⅱ scores of different Bell stages in treatment-remission group were significantly lower than those in death group (P <0.01). The score of SNAPPE-Ⅱ was significantly lower in the recovery group than that in the death group (P <0.01). At the time of diagnosis, the SNAPPE- Ⅱ score was significantly lower than the death group, the difference between the two groups was statistically significant (P <0.01). Conclusion: The worse the staging of Bell, the higher the SNAPPE-Ⅱ score and the higher the case fatality rate. SNAPPE-Ⅱ score combined with Bell staging can predict the prognosis and surgical risk of NEC, which is of great significance for the early prediction of the risk of death in children with NEC.