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目的探讨小儿危重病例评分(PCIS)及第三代小儿死亡危险评分(PRISMⅢ)在儿童手足口病并脑炎病情评估及预后判断中的应用价值。方法分别用PCIS及PRISMⅢ对2010年收住院的手足口病并脑炎患儿进行评分,分非危重组、危重组和极危重组,比较各组间的死亡率,运用ROC曲线比较两者在预判手足口病并脑炎患儿死亡风险的特异性和灵敏度。结果 1PCIS评分:3组死亡率比较差异有统计学意义(8/466,10/12,5/5,χ~2=93.099,P<0.001);2PRISMⅢ评分:3组比较死亡率,差异亦有统计学意义(4/458,4/7,15/18,χ~2=114.579,P<0.001);32种评分的非危重组、危重组和极危重组组间死亡率比较,差异均无统计学意义(1.72%vs.0.87%,χ~2=1.282,P=0.258,88.24%vs.76.00%,χ~2=0.349,P=0.555);4Logistic回归分析显示:PCIS各评分指标中,心率、血压(收缩压)及肾功能,PRISMⅢ各评分指标中,神志状态及血糖对手足口病死亡风险预测作用较强(P均<0.05)。5ROC曲线下面积分别为:PCIS评分0.929,PRISMⅢ评分0.985。结论 PCIS和PRISMⅢ均可用于手足口病并脑炎患儿病情的评估,两者在预测其死亡风险方面有较高的特异性和灵敏度。
Objective To investigate the value of PCIS and PRISMⅢ in the assessment and prognosis of HFMD and encephalitis in children. Methods The children with HFMD and encephalitis admitted to hospital in 2010 were scored by PCIS and PRISM Ⅲ respectively. The patients in non-critically ill group, critically ill group and critically endangered group were compared. The ROC curves were compared between the two groups Predict the specificity and sensitivity of risk of death in hand, foot and mouth disease and encephalitis. Results 1PCIS score: The mortality of 3 groups was significantly different (8 / 466,10 / 12,5 / 5, χ ~ 2 = 93.099, P <0.001); 2PRISMⅢscore: Statistical significance (4 / 458,4 / 7,15 / 18, χ ~ 2 = 114.579, P <0.001). There was no significant difference in the mortality rates between the non-critically ill, critically ill and critically ill groups Statistical analysis showed that there were statistically significant differences between the two groups (P <0.05) .4 Logistic regression analysis showed that among all the scores of PCIS, Heart rate, blood pressure (systolic blood pressure) and renal function, PRISMⅢ score indicators, the state of mind and blood sugar on foot and mouth disease mortality risk prediction stronger (P all <0.05). The areas under the 5ROC curve were: PCIS score 0.929, PRISM III score 0.985. Conclusion Both PCIS and PRISM Ⅲ can be used for the evaluation of children with HFMD and encephalitis, both of which have higher specificity and sensitivity in predicting the risk of death.